Treatment of periprosthetic acetabular fractures after previous hemi- or total hip arthroplasty: Introduction of a new implant.

H Resch,P Moroder,D Krappinger,M Blauth,J Becker

doi:10.1007/s00064-016-0439-7

Abstract

ObjectiveTreatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization.IndicationsAcetabular fracture with or without previous hemi- or total hip arthroplasty.ContraindicationsNon-displaced acetabular fractures.Surgical techniqueWatson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components.Postoperative managementFull weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended.ResultsOf 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery.LimitationsIn case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.

Highlights

Introduction of a new implantIntroductory remarksPeriprosthetic acetabular fractures are severe complications of hemi- (HA) or total hip arthroplasty (THA), and are on the rise in terms of occurrence and recognition [1,2,3,4,5]
As the function of implants in hip replacement is based on the bone–cement or bone–prosthesis fixation, a fracture that interrupts this fixation presents a challenging situation
A custom-built roof-reinforcement plate was designed in an attempt to provide sufficiently stable fixation at the intact iliac bone, in order to allow for early postoperative full weight-bearing in periprosthetic acetabular fractures (

Summary

Introduction

Periprosthetic acetabular fractures are severe complications of hemi- (HA) or total hip arthroplasty (THA), and are on the rise in terms of occurrence and recognition [1,2,3,4,5]. Acetabular implants favoring stable fixation and immediate postoperative mobilization with full weight-bearing are thought to be the solution. For this purpose, a custom-built roof-reinforcement plate was designed in an attempt to provide sufficiently stable fixation at the intact iliac bone, in order to allow for early postoperative full weight-bearing in periprosthetic acetabular fractures The purpose of this article is to provide a description of the novel implant and describe the surgical technique

Results

Discussion

Conclusion