Primary total hip arthroplasty for acetabular fractures in elderly patients

Abstract

Introduction: Life expectancy has risen, leading to an increase in acetabular fractures in fragile patients. Total hip arthroplasty with a reinforcement cage is a technically complex option, but allows fracture control and early mobilization. Our aim is to assess whether the use of Burch-Schneider cage in fragile patients with acetabular fractures allows immediate load stabilization without threatening the early survival of the arthroplasty.

Material and methods: Descriptive study of a series of 14 patients with acetabular fractures treated by a reinforcement cage associated with autologous bonegraft plus a cemented acetabular cup, and mobilization and bearing. Judet Letournel fracture types, surgical delay, and complications during admission were analyzed. Following hospital discharge we recorded the incorporation of grafts according to Gie's classification, presence of calcifications according to Brooker, consolidation of the fracture, loosening of implants and functional aspects according to the HHS and Merlé D'Aubigné Postel score.

Results: The most common fracture was both columns (6/14), with a surgical delay being of 11 days mean and 21,5 days of length of stay. One patient died after surgery. The mean follow-up was 34.4 months. All fractures healed and the bonegraft was incorporated in all cases. The mean HHS was 82 points and the Merle Score was 15/18. There were no complications related to arthroplasty.

Conclusions: Total hip arthroplasty with Burch-Schneider cage on bonegraft and no added osteosynthesis is a good option of treatment of all types of displaced acetabular fractures in a fragile patient.

Keywords: Acetabular; Acetábulo; Anciano; Arthroplasty; Artroplastia; Cadera; Elderly; Fractura; Fracture; Hip.