Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival.

Abstract:

PURPOSE:Occult intra-operative periprosthetic acetabular fracture is a seldom-reported complication of primary total hip arthroplasty (THA). It may potentially be associated with cup instability and implant loosening. The present study aimed to investigate clinical consequences of this complication. METHODS:Between 2003 and 2012, a total of 3390 cementless total hip arthroplasties (THA) were performed at our institution. Their medical histories were retrospectively reviewed to identify all patients who received a thin-layer computer tomography (CT) scan of the pelvis including the acetabulum within the first 30 post-operative days. They were evaluated and classified by two radiologists independently with respect to the presence of recent acetabular fractures. All cases with acetabular and periacetabular fractures were included in this study. Electronic medical records were reviewed to assess implant revision. Cup stability was measured with EBRA (Einzel-Bild-Röntgen-Analyse) from plain X-rays. RESULTS:Periprosthetic fractures of the acetabulum were identified in 58 (50.4%) of 115 selected patients. Fractures close to but not including the acetabulum were identified in 45% (n = 26/58) of the patients, at the superolateral wall in 17% (n = 10/58), at the anterior wall of the acetabulum in 16% (n = 9/58) and in 10% (n = 6/58) each at the medial wall, and at the posterior wall respectively. One out of these 58 fractures could not be classified. Three of a total of six occult medial wall fractures had to be revised, and another two showed a high implant migration. The highest cup migration values however were found after fractures of the superolateral wall. Incomplete column fractures did not influence implant survival. CONCLUSION:Central wall acetabular fractures, although unrecognized intra- and post-operatively may impair implant survival after THA.

journal_name

Int Orthop

authors

Dammerer D,Putzer D,Glodny B,Petersen J,Arrich F,Krismer M,Biedermann R

doi

10.1007/s00264-018-4084-7

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

1583-1590

issue

7

eissn

0341-2695

issn

1432-5195

pii

10.1007/s00264-018-4084-7

journal_volume

43

pub_type

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