Patients with previous acetabular fracture fixation may have improved outcomes after THA
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Key takeaways:
- Results showed patients had a 15-year implant survivorship free of any revision of 98%.
- Researchers found all unrevised components were radiographically well-fixed.
Results published in The Journal of Arthroplasty showed total hip arthroplasty may be associated with improved outcomes among patients with previous operative fixation of acetabular fractures.
“In the past, conversion of a THA for a failed acetabular fracture (usually due to posttraumatic arthritis) carried with it a high rate of failure, mainly due to implant loosening and/or bearing surface wear,” Daniel J. Berry, MD, the L.Z. Gund Professor of Orthopedic Surgery at Mayo Clinic, told Healio. “Our new paper shows that with modern acetabular reconstruction techniques and modern uncemented acetabular components the rate of failure due to aseptic loosening has been markedly reduced in these patients who often have compromised acetabular bone due to their previous acetabular fracture.”
Berry and colleagues collected data from 104 patients with a history of open reduction and internal fixation of an acetabular fracture followed by ipsilateral primary THA between January 2000 and December 2015. Researchers followed up with patients 1, 2 and 5 years postoperatively, as well as at subsequent 5-year intervals. Outcomes measured included implant survivorship, complications, radiographic outcomes and Harris Hip Scores.
Researchers found a 15-year implant survivorship free of any revision of 98%, and a 15-year survivorship free of acetabular revision of 100%. In addition, researchers found 2-, 10- and 15-year survivorships free of reoperation of 98%, 97% and 92%, respectively.
Patients also had 1-, 5-, 10- and 15-year survivorships free of postoperative complications of 93%, 90%, 88% and 82%, respectively, while the 15-year survivorship free of hip dislocation was 94%.
Radiographically, researchers found 100% of components that did not require revision were well-fixed. Researchers also found the mean Harris Hip Score of the patient population improved from 52 at preoperative baseline to 83 at 2 years, 80 at 5 years and 86 at 10 years postoperatively.
“Modern uncemented implants and modern bearing surfaces have changed an operation that once had a high failure rate by 10 years to one with a low failure rate at 10 years,” Berry said.
He added, “We will continue to monitor this cohort of patients to determine if these midterm follow-up results continue to be favorable at longer-term follow-up.”
Perspective
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The authors reviewed patients who underwent THA after acetabular fracture open reduction and internal fixation between January of 2000 and December of 2015. Due to previous studies reporting poor survivorship with earlier techniques, the authors’ purpose of the study was to report the outcomes on a large case series of patients undergoing arthroplasty with contemporary techniques.
The strengths of this article include the relatively large number of cases, length of follow-up, that they had so many different surgeons and the survival rate was so high. Fifteen-year survivorship free of revision was 98%, and 93% free of any postoperative complication is great information to present to patients considering surgery. Only one patient had acetabular component aseptic loosening at 18 years postoperatively. More importantly, postoperative Harris Hip Scores significantly improved compared to their preoperative scores and were maintained, for the most part, for 10 years. I think, in general, the conversion to THA after acetabular fracture is underreported due to the regional nature of trauma centers for acute acetabular fracture care, and this article will help those who take care of these patients feel more confident in the THA survivorship and outcomes for these typically young patients.
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