Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly pati
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ORIGINAL PAPER
Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly patients: a retrospective observational cohort study of fifty one patients Xavier Lannes 1 & Kevin Moerenhout 1 & Hong Phuoc Duong 2 & Olivier Borens 1 & Sylvain Steinmetz 1 Received: 4 April 2020 / Accepted: 27 July 2020 # The Author(s) 2020
Abstract Purposes Acetabular fractures are more and more common in the elderly. Open reduction and internal fixation (ORIF) may lead to poor outcomes and high revision rates. Primary total hip arthroplasty (THA) combined with internal fixation, also known as the combined hip procedure (CHP), associated with dual mobility cup (DM-CHP) could be an efficient procedure in selected elderly patients. The aim of this study is to compare functional and radiological outcomes between ORIF and DM-CHP. Methods Between 2007 and 2018, 51 patients older than 65 years were surgically treated for acetabular fractures. Twenty-six patients were treated by DM-CHP and 25 by ORIF. Each group was divided into two subgroups regarding a single or combined approach. Hospital stay, surgical time, intraoperative blood loss, and complications were documented. The Harris Hip Score (HHS) was used for measuring the functional outcome. Radiological analysis was used to assess the centre of rotation in the DMCHP group. Results Median surgery time and intra-operative blood loss were higher in DM-CHP than those in ORIF. Early medical complication rate was higher for a combined approach as compared with a single posterior approach in DM-CHP (p = 0.003). Dislocation rate was 7.7% in DM-CHP. Revision rate was higher in ORIF (20% versus 7.7%). HHS was similar in both groups. Conclusions DM-CHP leads to similar functional outcomes and less revision than ORIF. This study strengthens the practice of using only the posterior approach for primary THA in the elderly. Dual mobility is a valid therapeutic option for acetabular fractures in elderly patients. Keywords Combined hip procedure . Open reduction internal fixation . Dual mobility cup . Acetabular fractures . Center of rotation . Elderly patient
* Sylvain Steinmetz [email protected] Xavier Lannes [email protected] Kevin Moerenhout [email protected] Hong Phuoc Duong [email protected] Olivier Borens [email protected] 1
Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
2
Institute for Research in Rehabilitation, Clinique romande de réadaptation Sion, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
Introduction Acetabular fractures in patients aged 60 years and older have steadily become more frequent with a report of a 2.4-fold increase in incidence [1]. Kannus et al. [2] have also shown a rise of 23% of osteoporotic pelvic fractures with an ever older population. Low-energy trauma (LE) accounts for more than 50% of elderly acetabular fractures [3], which normally lead to a “senior fracture pattern”. T
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