Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

Abstract

Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d'Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d'Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications

“…We obtained the full-text of all potentially relevant reports and two review authors (EL, HP) independently screened all full-text reports for inclusion and exclusion criteria. Twenty-five articles were excluded after full text review for the following reasons: seven non-English language articles, 10 , 11 , 12 , 13 , 14 , 15 , 16 eight articles describing acute fracture management or lacking delayed THA, 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 eight articles with insufficient sample size (case reports and review articles), 5 , 6 , 25 , 26 , 27 , 28 , 29 , 30 one article with insufficient outcome data or follow-up duration, 31 and one article with co-occurring femur fractures and other ipsilateral injuries. 32 Cases of disagreement were resolved by discussion, and if no consensus was reached a third review author (SN) was consulted to make the decision.…”

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

“…Several authors have referenced the paucity of information on HE skeletal trauma in the elderly. 8,10,11 Indeed, a recent review highlighted the lack of information on this increasingly important injury. 1,12…”

Three Year Experience of Treating the Acetabular Fracture with Reconstruction Plate at Civil Hospital Karachi

“…In 2017, another analysis of 24 elderly osteoporotic patients treated for acetabular fracture were evaluated for clinical outcomes, with a mean follow up period of 49 months after surgery. The results of the study showed no complication after the perioperative period, the mean Harris Hip Score was noted as 92 & no acetabular components were loose on latest radiographs or clinically, 13 of 14 hips rated as good or excellent 21 . A study conducted at Sanjay Gandhi Institute of Trauma and Orthopaedics.…”