Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

Tzu-Chun Chung,Tzu-Shan Chen,Feng-Chen Kao,Yuan-Kun Tu,Yao-Chun Hsu,Pao-Hsin Liu,Pil Whan Yoon

doi:10.1371/journal.pone.0231092

Tzu-Chun Chung, Tzu-Shan Chen + Show 5 more

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https://doi.org/10.1371/journal.pone.0231092

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Abstract

Background/objectiveOsteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group.DesignA retrospective population-based cohort study.SettingData were gathered from the Taiwan National Health Insurance Research Database.ParticipantsWe enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period.ResultsThe THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001).ConclusionThe incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

Highlights

The total hip arthroplasty (THA) rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. They were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group
Pelvic and acetabular fractures primarily result from high-energy trauma in relatively young patients
Intra-articular procedures, is commonly recommended for acetabular fractures to facilitate recovery of joint congruency.[1],[5,6,7,8] Posttraumatic hip arthritis often occurs after acetabular fractures and is accelerated by malreduction during surgery

Summary

Introduction

Pelvic and acetabular fractures primarily result from high-energy trauma in relatively young patients (less than 40 year-old). The cause may be low-energy trauma, such as that induced by minor falls.[1,2,3] Pelvic and acetabular fractures affect the pelvic ring structure and blood supply changes and may cause posttraumatic osteoarthritis and total hip arthroplasty (THA) for these patients.[4] Surgical intervention, intra-articular procedures, is commonly recommended for acetabular fractures to facilitate recovery of joint congruency.[1],[5,6,7,8] Posttraumatic hip arthritis often occurs after acetabular fractures and is accelerated by malreduction during surgery. The incidence of radiographic arthritis after acetabular fixation has been reported to be in the range of 20%–40%, with a subsequent THA rate of 8%–34%.[5,6]

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