Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly

  • Mathias van den Broek (Department of Orthopaedic Surgery, az Sint-Blasius) ;
  • Kris Govaers (Department of Orthopaedic Surgery, az Sint-Blasius)
  • Received : 2022.09.18
  • Accepted : 2022.11.25
  • Published : 2023.03.31
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Abstract

Purpose: The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods: A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results: Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion: Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.

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References

  1. Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7:128-41. https://doi.org/10.5435/00124635-199903000-00006
  2. Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92:250-7. https://doi.org/10.1302/0301-620X.92B2.22488
  3. Harper CM, Lyles YM. Physiology and complications of bed rest. J Am Geriatr Soc. 1988;36:1047-54.  https://doi.org/10.1111/j.1532-5415.1988.tb04375.x
  4. Magu NK, Rohilla R, Arora S. Conservatively treated acetabular fractures: a retrospective analysis. Indian J Orthop. 2012;46:36-45. https://doi.org/10.4103/0019-5413.91633
  5. Wollmerstadt J, Pieroh P, Schneider I, et al. Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum. BMC Geriatr. 2020;20:66. https://doi.org/10.1186/s12877-020-1471-x
  6. Gary JL, Lefaivre KA, Gerold F, Hay MT, Reinert CM, Starr AJ. Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly. Injury. 2011;42:1144-51. https://doi.org/10.1016/j.injury.2010.08.035
  7. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005;87:2-9.  .https://doi.org/10.1302/0301-620X.87B1.15605
  8. Weber M, Berry DJ, Harmsen WS. Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am. 1998;80:1295-305. https://doi.org/10.2106/00004623-199809000-00008
  9. Capone A, Peri M, Mastio M. Surgical treatment of acetabular fractures in the elderly: a systematic review of the results. EFORT Open Rev. 2017;2:97-103. https://doi.org/10.1302/2058-5241.2.160036
  10. Daurka JS, Pastides PS, Lewis A, Rickman M, Bircher MD. Acetabular fractures in patients aged > 55 years: a systematic review of the literature. Bone Joint J. 2014;96-B:157-63. https://doi.org/10.1302/0301-620X.96B2.32979
  11. De Bellis UG, Legnani C, Calori GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury. 2014;45:356-61. https://doi.org/10.1016/j.injury.2013.09.018
  12. Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002;84:1-9. https://doi.org/10.2106/00004623-200201000-00001
  13. Jauregui JJ, Weir TB, Chen JF, et al. Acute total hip arthroplasty for older patients with acetabular fractures: a metaanalysis. J Clin Orthop Trauma. 2020;11:976-82.  https://doi.org/10.1016/j.jcot.2020.01.003 14.Gautam D, Gupta S, Malhotra R. Total hip arthroplasty in acetabular fractures. J Clin Orthop Trauma. 2020;11:1090-
  14. Erratum in: J Clin Orthop Trauma. 2021;21:101558. https://doi.org/10.1016/j.jcot.2020.10.037
  15. Meek RM, Allan DB, McPhillips G, Kerr L, Howie CR. Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res. 2006;447:9-18. https://doi.org/10.1097/01.blo.0000218754.12311.4a
  16. Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty. 2007;22(4 Suppl 1):86-90. https://doi.org/10.1016/j.arth.2006.12.111
  17. Darrith B, Courtney PM, Della Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2018;100-B:11-9. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0462.R1
  18. De Martino I, D'Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J. 2017;99-B(ASuppl1):18-24. Erratum in: Bone Joint J. 2017;99-B:702-4. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0398.R1
  19. Abdel MP. Dual-mobility constructs in revision total hip arthroplasties. J Arthroplasty. 2018;33:1328-30. https://doi.org/10.1016/j.arth.2018.01.030
  20. Plummer DR, Christy JM, Sporer SM, Paprosky WG, Della Valle CJ. Dual-mobility articulations for patients at high risk for dislocation. J Arthroplasty. 2016;31(9 Suppl):131-5. https://doi.org/10.1016/j.arth.2016.03.021
  21. Moreta J, Uriarte I, Foruria X, Urra I, Aguirre U, Martinezde Los Mozos JL. Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty. Hip Int. 2021;31:97-102. https://doi.org/10.1177/1120700019873617
  22. Gabor JA, Feng JE, Gupta S, et al. Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty. Arthroplast Today. 2019;5:341-7. https://doi.org/10.1016/j.artd.2019.05.001
  23. Evangelista PJ, Okroj K, Plummer D, Della Valle CJ, Schwarzkopf R. Do cemented dual-mobility cups confer stability for patients at high risk of dislocation in revision total hip arthroplasty? J Hip Surg. 2018;02:088-91. https://doi.org/10.1055/s-0038-1661341
  24. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;(151):81-106.
  25. Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am. 1990;72:501-8.
  26. Henry PD, Kreder HJ, Jenkinson RJ. The osteoporotic acetabular fracture. Orthop Clin North Am. 2013;44:201-15.  https://doi.org/10.1016/j.ocl.2013.01.002
  27. Tidermark J, Blomfeldt R, Ponzer S, Soderqvist A, Tornkvist H. Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients. J Orthop Trauma. 2003;17:193-7. https://doi.org/10.1097/00005131-200303000-00007
  28. Enocson A, Blomfeldt R. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma. 2014;28:330-7. https://doi.org/10.1097/BOT.0000000000000016
  29. Liaw F, Govilkar S, Banks D, Kankanalu P, Youssef B, Lim J. Primary total hip replacement using Burch-Schneider cages for acetabular fractures. Hip Int. 2022;32:401-6. https://doi.org/10.1177/1120700020957642
  30. Heller S, Brosh T, Kosashvili Y, Velkes S, Burg A, Dudkiewicz I. Locking versus standard screw fixation for acetabular cups: is there a difference? Arch Orthop Trauma Surg. 2013;133:701-5. https://doi.org/10.1007/s00402-013-1709-6
  31. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12:205-12. https://doi.org/10.5435/00124635-200407000-00001
  32. Milne LP, Kop AM, Kuster MS. Polyaxial locking and compression screws improve construct stiffness of acetabular cup fixation: a biomechanical study. J Arthroplasty. 2014;29:1043-51. https://doi.org/10.1016/j.arth.2013.11.007