Does Cup-cage Reconstruction With Oversized Cups Provide Initial Stability in THA for Osteoporotic Acetabular Fractures?

Abstract

Background The incidence of acetabular fractures in osteoporotic patients is increasing. Immediate total hip arthroplasty (THA) has potential advantages, but achieving acetabular component stability is challenging and, at early followup, reported revision rates for loosening are high. Questions/purposes This study measured acetabular component stability and the initial surface contact achieved between the acetabular component and unfractured region of the pelvis after THA using an oversized acetabular component and cup-cage reconstruction. Methods Between November 2011 and November 2013, we treated 40 acute acetabular fractures in patients older than 70 years of age. Of these, 12 (30%) underwent immediate THA using an oversized acetabular component with screws inserted only into the ilium and a cup-cage construct. Postoperatively all patients were mobilized without weightbearing restrictions. Indications for immediate THA after acetabular fractures were displaced articular comminution deemed unreducible. Eleven of the 12 were prospectively studied to evaluate the initial stability of the reconstructions using radiostereometric analysis. One of the patients died of a pulmonary embolism after surgery, and the remaining 10 (median age, 81 years; range, 72-86 years) were studied. Of these, five were analyzed at 1 year and five were analyzed at 2 years. Acetabular component migration was defined as acceptable if less than the limits for primary THA that predict later loosening (1.76 mm of proximal migration and 2.53°of sagittal rotation). The contact surface between the acetabular component and ilium in direct continuity with the sacroiliac joint, and the ischium and pubis in direct continuity with the symphysis pubis, was measured on postoperative CT scans.Results At 1 year the median proximal migration was 0.83 mm (range, 0.09-5.13 mm) and sagittal rotation was 1.3°(range, 0.1°-7.4°).

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

“…However, to our knowledge there are only four studies that investigated the association between early migration of the femoral component in THAs and stem survival [11,14,17,19]. Whereas early migration measurement is commonly recommended as a valuable tool to detect unsafe and poor-performing implants early and to prevent their widespread use [16,30], there is a lack of studies that correlate early migration and late implant loosening in the same patient cohort, particularly regarding long-term observations ([ 10 years) [36]. Furthermore, and even more important, none of these previous studies [11,14,17,19] investigated this relationship exclusively for cementless femoral stems.…”

Pelvic fractures: epidemiology, consequences, and medical management

“…Acetabular fractures should be considered separately as they involve the hip joint; thus, unless there is minimal displacement and hip joint stability, surgical treatment is proposed: absolute operative indications include open fractures, hip joint instability and intra-articular loose bodies; hip joint incongruity and intra-articular displacement exceeding 2 or 3 mm may also be considered for surgery because of the early arthritis risk [15]. Studies [26,27] on technical aspects on this surgery have been recently published to try to improve the surgical benefit. In summary, the large majority of pelvic fractures do not require surgery, except acetabular fractures.…”

Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

“…Nowadays, with modern protrusion cages, the semielliptical cups, the mobility and the new double-coated hydroxyapatite femoral stems, the implant failure is very difficult, if not rare. Moreover, this implant can have a long life as a primary THA osteoarthritis implant [22][23][24][25][26][27]. In the literature, it is shown that the prosthesis in acetabular fracture outcomes has a higher bleeding compared to THA and ORIF in acute trauma [1,28].…”