Conversion Total Hip Arthroplasty with a Direct Anterior Approach for Failed Treatment of Acetabular Fractures
Total hip arthroplasty (THA) is a salvage procedure after failed treatment of acetabular fractures. Technical challenges increase the risk of perioperative complications, specifically nerve palsy and dislocation. The direct anterior approach (DAA) was evaluated to mitigate these risks. Clinical and radiographic outcomes were reviewed retrospectively. Thirteen patients underwent conversion THA. Of the 13, nine had been treated with open reduction internal fixation (ORIF), one with traction, and three conservatively. When possible, retained hardware was deliberately left in place. At a mean follow-up of 4 years, there were no major complications, readmissions, revisions, or deaths. Two nonunions managed with autografting went on to union. The mean HOOS (hip disability and osteoarthritis outcome) Jr score at follow-up was 89. These data suggest that the DAA may be a reasonable alternative to the posterior approach in this high-risk population.
Keywordsacetabular fracture - total hip arthroplasty - direct anterior approach - nerve palsy - dislocation
Received: 31 March 2020
Accepted: 26 May 2020
22 September 2020 (online)
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- 1 Giannoudis PV, Grotz MRW, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br 2005; 87 (01) 2-9
- 2 Bellabarba C, Berger RA, Bentley CD. , et al. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am 2001; 83 (06) 868-876
- 3 Morison Z, Moojen DJF, Nauth A. , et al. Total hip arthroplasty after acetabular fracture is associated with lower survivorship and more complications. Clin Orthop Relat Res 2016; 474 (02) 392-398
- 4 Berry DJ, Halasy M. Uncemented acetabular components for arthritis after acetabular fracture. Clin Orthop Relat Res 2002; (405) 164-167
- 5 Stibolt Jr RD, Patel HA, Huntley SR, Lehtonen EJ, Shah AB, Naranje SM. Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: a systematic review of characteristics, outcomes, and complications. Chin J Traumatol 2018; 21 (03) 176-181
- 6 Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res 1980; (151) 81-106
- 7 Lyman S, Lee Y-Y, Franklin PD, Li W, Mayman DJ, Padgett DE. Validation of the HOOS, JR: a short-form hip replacement survey. Clin Orthop Relat Res 2016; 474 (06) 1472-1482
- 8 Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005; 441 (441) 115-124
- 9 Makridis KG, Obakponovwe O, Bobak P, Giannoudis PV. Total hip arthroplasty after acetabular fracture: incidence of complications, reoperation rates and functional outcomes: evidence today. J Arthroplasty 2014; 29 (10) 1983-1990
- 10 Zhang L, Zhou Y, Li Y, Xu H, Guo X, Zhou Y. Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study. J Arthroplasty 2011; 26 (08) 1189-1193
- 11 Ranawat A, Zelken J, Helfet D, Buly R. Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplasty 2009; 24 (05) 759-767
- 12 Gavaskar AS, Gopalan H, Karthik B, Srinivasan P, Tummala NC. Delayed total hip arthroplasty for failed acetabular fractures: the influence of initial fracture management on outcome after arthroplasty. J Arthroplasty 2017; 32 (03) 872-876
- 13 Lai O, Yang J, Shen B, Zhou Z, Kang P, Pei F. Midterm results of uncemented acetabular reconstruction for posttraumatic arthritis secondary to acetabular fracture. J Arthroplasty 2011; 26 (07) 1008-1013
- 14 Romness DW, Lewallen DG. Total hip arthroplasty after fracture of the acetabulum. Long-term results. J Bone Joint Surg Br 1990; 72 (05) 761-764