Management of periprosthetic acetabular fractures in elderly patients--a minimally invasive approach.

Abstract

Periprosthetic acetabular fractures are rare and in the current literature largely underreported. The management is reported to be difficult. Treatment varies from non-operative to open reduction and internal fixation up to revision of the acetabular components. A prospective consecutive case series in acetabular fractures was performed in a level 1 trauma centre. All patients with pre-existing total hip replacement were followed up for one year. Perioperative data, complications, radiological results, functional outcome and quality of life were measured. Eight (15%) of 53 patients who were included in the study underwent total hip arthroplasty before and had stable implants at time of fracture. Mean age of the patients was 83 years. All of them were female. Mean operative time was 85 minutes. There were no soft tissue complications like infection or nerve damage in the post-operative course. No revision was needed. Two patients died in between the follow up. The Harris hip score was a mean of 77, with quality of life comparable to persons in the same age. Minimally invasive reconstruction of the anterior column is a viable method to conserve stable acetabular components in this type of fracture. Short operation time and limited incisions are the most conclusive advantages.