Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications

Abstract

Background Despite modern fracture management techniques allowing for near anatomic reduction of acetabular fractures, there continues to be a risk of posttraumatic arthritis and need for total hip arthroplasty (THA). Few well-controlled studies have compared THA after acetabular fractures with THAs performed for other indications in terms of survivorship or complications, and none, to our knowledge, present 10-year survivorship data in this setting. Questions/purposes (1) How does the 10-year survival of THA compare between those patients who underwent THA after an acetabular fracture and those who underwent THA for primary arthritis or avascular necrosis (AVN)? (2) Is there an increased risk of serious complications like infection, dislocation, and aseptic loosening as well as heterotopic ossification associated with a THA performed after a previous acetabular fracture? Methods This retrospective case-control study compared findings of patients who underwent THA after acetabular fracture versus a matched cohort of patients who had received a primary THA for primary osteoarthritis or AVN. Between 1987 and 2011, we performed 95 THAs after acetabular fracture; of those, 74 (78%) met inclusion criteria and had documented followup beyond 2 years in our institutional registry. We selected 74 matched patients based on an algorithm that matched patients based on preoperative diagnosis, date of operation, age, gender, and type of prosthesis. During this time, we performed approximately 8000 THAs that were potentially available for matching based on complete followup beyond 2 years. We compared cases and control subjects using the KaplanMeier survivorship estimator as well as a comparison of the proportions in each group that developed major complications (including infection, dislocation, loosening, and heterotopic ossification) based a retrospective chart review. Results The 10-year survivorship after THA was lower in patients with a previous acetabular fracture than in the matched cohort (70%, 95% confidence interval [CI], 64%-78%, versus 90%, 95% CI, 86-

Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures

“…Other authors have not confirmed these excellent results, i.e. Morrison showed a 10-year survival rate of 70% for uncemented acetabular components [26]. A review from 2014 could not show statistically significant differences in survival between cemented and uncemented components [20].…”

Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

“…No clear consensus can be found in the literature on which technique is preferable, and good results are found for all alternatives 90,97,98 . Compared to THA for non-traumatic OA the outcome is, however, notably worse and the complication rate higher 98,99 .…”

“…THA after post traumatic arthritis or avascular necrosis associated with acetabular fractures, will markedly improve patients' quality of life 88,89,156 , but it is associated with a higher rate of complications, reduced long time survival 90,98,99 and less improvement on patients symptoms 157,158 compared to a primary total hip replacement. In fact, the results after secondary THA in acetabular fractures are similar to that of revision arthroplasty 159,160 .…”

Should Total Hip Arthroplasty be Performed Acutely in the Treatment of Acetabular Fractures in Elderly or Used as a Salvage Procedure Only?

“…Morison et al .,48 however, found higher rates of survival in the PTOA group (70% vs. 90%) and when only considering aseptic loosening – 77% versus 90%. Complication rates are higher in the PTOA group, equivalent to revision procedures,28 and Morison et al 48. had an infection rate of 7% in their PTOA group versus no infections in DOA group – they noted previous fixation was a risk for infection.…”