Cementless Acetabular Reconstruction After Acetabular Fracture

• Published in: Journal of bone and joint surgery. American volume 2001-06, Vol.83 (6), p.868-876
• Main Authors: Bellabarba, Carlo, Berger, Richard A, Bentley, Christian D, Quigley, Laura R, Jacobs, Joshua J, Rosenberg, Aaron G, Sheinkop, Mitchell B, Galante, Jorge O
• Format: Article
• Language: English
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - injuries; Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthritis - etiology; Arthritis - surgery; Arthroplasty, Replacement, Hip - instrumentation; Cementation; Female; Follow-Up Studies; Fractures, Bone - complications; Fractures, Bone - therapy; Hip Joint - diagnostic imaging; Humans; Male; Middle Aged; Ossification, Heterotopic - etiology; Postoperative Complications; Prosthesis Failure; Radiography; Reoperation
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200106000-00008

BackgroundTotal hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate‐term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture.MethodsThirty total hip arthroplasties were performed with use of a cementless hemispheric, fiber‐metal-mesh-coated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture. The median interval between the fracture and the arthroplasty was thirty‐seven months (range, eight to 444 months). The average age at the time of the arthroplasty was fifty‐one years (range, twenty‐six to eighty‐six years), and the average duration of follow‐up was sixty‐three months (range, twenty‐four to 140 months). Fifteen patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and fifteen patients had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate‐term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis.ResultsOperative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis. Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods. Eight of the fifteen patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the fifteen patients who had been treated by closed means (p = 0.005). Two of the fift