Hip & pelvis

  • 제36권3호
  • /
  • Pages.179-186
  • /
  • 2024
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지
DOI QR코드

DOI QR Code

Management of Intraoperative Acetabular Fractures in Total Hip Arthroplasty: A Current Concept Review

  • Christian Hipfl (Department of Orthopedics, Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin) ;
  • Sebastian Hardt (Department of Orthopedics, Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin) ;
  • Carsten Perka (Department of Orthopedics, Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin)
  • 투고 : 2023.08.31
  • 심사 : 2023.12.28
  • 발행 : 2024.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Intraoperative acetabular fractures (IAFs), a complication seldomly encountered in total hip arthroplasty, are typically a result of the impact of insertion of a cementless press-fit cup. Factors that contribute to the risk of these types of fractures include poor bone quality, highly sclerotic bone, and the use of a press-fit cup that is excessively large. The approach to management of these fractures is dependent on when they are identified. Immediate stabilization measures should be implemented for management of fractures detected during surgery. When fractures are detected postoperatively, the decision regarding conservative treatment is dependent on the stability of the implant and the specific fracture pattern. In the majority of cases, effective treatment of an acetabular fracture detected intraoperatively can be administered using a multi-hole revision cup along with anchoring screws in the various regions of the acetabulum. Selection of plate osteosynthesis of the posterior column is recommended when there is a large posterior wall fragment or pelvic discontinuity. In cases where anatomical dimensions allow, cup-cage reconstruction may offer a promising alternative to a combined hip procedure. The number of reports addressing the management of IAFs is limited. This review focuses on outlining the strategies that are currently available for management of this seldomly encountered complication.

키워드

참고문헌

  1. Haidukewych GJ, Jacofsky DJ, Hanssen AD, Lewallen DG. Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am. 2006;88:1952-6.
  2. Sharkey PF, Hozack WJ, Callaghan JJ, et al. Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases. J Arthroplasty. 1999;14:426-31. https://doi.org/10.1016/s0883-5403(99)90097-9
  3. Kim YS, Callaghan JJ, Ahn PB, Brown TD. Fracture of the acetabulum during insertion of an oversized hemispherical component. J Bone Joint Surg Am. 1995;77:111-7. https://doi.org/10.2106/00004623-199501000-00013
  4. Brown JM, Borchard KS, Robbins CE, Ward DM, Talmo CT, Bono JV. Management and prevention of intraoperative acetabular fracture in primary total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2017;46:232-7.
  5. Laflamme GY, Belzile EL, Fernandes JC, Vendittoli PA, Hebert-Davies J. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial. J Arthroplasty. 2015;30:265-9. https://doi.org/10.1016/j.arth.2014.09.013
  6. Desai G, Ries MD. Early postoperative acetabular discontinuity after total hip arthroplasty. J Arthroplasty. 2011;26:1570. e17-9. https://doi.org/10.1016/j.arth.2010.12.021
  7. Dammerer D, Putzer D, Glodny B, et al. Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival. Int Orthop. 2019;43:1583-90. https://doi.org/10.1007/s00264-018-4084-7
  8. Hasegawa K, Kabata T, Kajino Y, Inoue D, Tsuchiya H. Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res. 2017;475:484-94. https://doi.org/10.1007/s11999-016-5138-z
  9. Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1206-13. https://doi.org/10.2106/00004623-199608000-00011
  10. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;(151):81-106.
  11. Callaghan JJ. Periprosthetic fractures of the acetabulum during and following total hip arthroplasty. Instr Course Lect. 1998;47:231-5.
  12. Della Valle CJ, Momberger NG, Paprosky WG. Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect. 2003;52:281-90.
  13. Pascarella R, Sangiovanni P, Cerbasi S, et al. Periprosthetic acetabular fractures: a new classification proposal. Injury. 2018;49 Suppl 3:S65-73. https://doi.org/10.1016/j.injury.2018.09.061
  14. Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B:713-6. https://doi.org/10.1302/0301-620X.96B6.34040
  15. Yamamuro Y, Kabata T, Kajino Y, Inoue D, Hasegawa K, Tsuchiya H. Does intraoperative periprosthetic occult fracture of the acetabulum affect clinical outcomes after primary total hip arthroplasty? Arch Orthop Trauma Surg. 2022;142:3497-504. https://doi.org/10.1007/s00402-021-04226-y
  16. Rogers BA, Whittingham-Jones PM, Mitchell PA, Safir OA, Bircher MD, Gross AE. The reconstruction of periprosthetic pelvic discontinuity. J Arthroplasty. 2012;27:1499-506.e1. https://doi.org/10.1016/j.arth.2011.12.017
  17. Takigami I, Ito Y, Mizoguchi T, Shimizu K. Pelvic discontinuity caused by acetabular overreaming during primary total hip arthroplasty. Case Rep Orthop. 2011;2011:939202. https://doi.org/10.1155/2011/939202
  18. Lin C, Caron J, Schmidt AH, Torchia M, Templeman D. Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma. 2015;29:151-9. https://doi.org/10.1097/BOT.0000000000000164
  19. De Bellis UG, Legnani C, Calori GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury. 2014;45:356-61. https://doi.org/10.1016/j.injury.2013.09.018
  20. Borg T, Hernefalk B, Hailer NP. Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: a short-term comparison with internal fixation alone after a minimum of two years. Bone Joint J. 2019;101-B:478-83. https://doi.org/10.1302/0301-620X.101B4.BJJ-2018-1027.R2
  21. Malhotra R, Gautam D. Cup-cage construct using porous cup with Burch-Schneider cage in the management of complex acetabular fractures. Hip Pelvis. 2019;31:87-94. https://doi.org/10.5371/hp.2019.31.2.87
  22. Konan S, Duncan CP, Masri BA, Garbuz DS. The cup-cage reconstruction for pelvic discontinuity has encouraging patient satisfaction and functional outcome at median 6-year follow-up. Hip Int. 2017;27:509-13. https://doi.org/10.5301/hipint.5000480
  23. Abolghasemian M, Tangsaraporn S, Drexler M, et al. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term. Bone Joint J. 2014;96-B:195-200. https://doi.org/10.1302/0301-620X.96B2.31907
  24. Hipfl C, Janz V, Lochel J, Perka C, Wassilew GI. Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity: mid-term results of a consecutive series of 35 cases. Bone Joint J. 2018;100-B:1442-8. https://doi.org/10.1302/0301-620X.100B11.BJJ-2018-0481.R1