Total hip arthroplasty for the treatment of osteoarthritis secondary to acetabular fractures treated by open reduction a
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ORIGINAL ARTICLE • HIP - ARTHROPLASTY
Total hip arthroplasty for the treatment of osteoarthritis secondary to acetabular fractures treated by open reduction and internal fixation Peter Dawson1 · Lisa Dunne1 · Hasnain Raza1 · Mark Quinn1 · Michael Leonard1 Received: 20 November 2018 / Accepted: 20 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
Abstract Background Acetabular fractures are associated with damage to the femoral head, acetabular cartilage and labrum and possible disruption of the femoral head blood supply. Treatment aims to provide the best opportunity for restoration of joint function and to prevent long-term complications. Surgical intervention, in the form of open reduction and internal fixation (ORIF), is often required. Where post-traumatic osteoarthritis develops after ORIF, total hip arthroplasty (THA) is often required. Our aim here has been to identify and highlight our experience with the key technical points associated with successful outcomes for THA in this setting. Methods A single-centre retrospective review of patients with acetabular fractures treated with ORIF and subsequent THA over a 4-year period was undertaken. Demographics, mechanism of injury, complications, interval time between surgeries, intra-operative outcomes and post-operative outcomes were recorded. Particular emphasis is made to describe standard preoperative and intra-operative protocols. Results Twenty-five patients were identified, with a mean age of 51.1 years at time of first ORIF. 60% presented following RTA. 80% of fractures involved the posterior wall or column. Meantime to eventual THA was 2.3 years. Mean THA duration was 1.52 h, with mean intra-operative blood loss and length of stay of 585 ml and 5 days, respectively. 24% required intra-operative removal of metal, with only one patient suffering a complication post-THA. Conclusion Acceptable post-operative outcomes were demonstrated throughout the case series. In describing the pre-operative work up, intra-operative findings and intra-operative and post-operative complications encountered, common important technical points associated with a successful surgical strategy are described. Furthermore, potential pitfalls that may be encountered can be anticipated. Keywords Arthroplasty · Hip · Revision · Acetabular fracture
Introduction Acetabular fractures and their associated injuries to acetabular and femoral cartilage and femoral head blood supply will frequently lead to post-traumatic arthritis. For displaced fractures, surgical intervention with open reduction and internal fixation (ORIF) has been demonstrated to optimise joint function [1–6] and ultimately reduce the risk of developing post-traumatic arthritis. ORIF does not eliminate this risk however. Variable rates are reported for the development * Peter Dawson [email protected] 1
The National Centre for the Treatment of Pelvic and Acetabular Fractures, Tallaght University Hospital, Dublin, Ireland
of post-traumatic arthritis following ORIF of acetabular fr
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