OTA 1997 Posters - Pelvic & Acetabular Fractures

Early Failure following Operative Treatment of Acetabular Fractures Leading to Total Hip Arthroplasty

Arthur L. Malkani, MD, Edward O'Mara, MD, Cyna Khalily, MD

University of Louisville, Louisville, Kentucky, USA

Purpose: To identify early causes of failure following operative treatment of acetabular fractures.

Methods: Ninety-four consecutive patients who underwent operative treatment of an acetabular fracture were retrospectively reviewed. All procedures were performed by a single surgeon. Patients were managed preoperatively and postoperatively using a specific protocol which included DVT prophylaxsis, intra-operative EMG monitoring, and Indocin to avoid heterotopic ossification. Intraoperative Judet views were utilized to check the accuracy of the articular cartilage reduction and location of the hardware. The surgical approaches included a Kocher-Langenbeck, an ilio-inguinal or both, and in one case an extended ilio-femoral approach based on the fracture pattern. Patients were asked to follow-up postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years.

Results: At latest review, 85 patients were available for review with a minimum follow-up of 1 year. There were 61 males and 25 females with an average age of 38 years. Seven patients at latest follow-up underwent total hip arthroplasty and two patients are pending hip replacement with an overall failure rate of 11%. Five of the seven patients (6%) required total hip arthroplasty within six months from the time of surgery due to chondrolysis or an undetected fracture of the femoral head. The average of the patients in the group that were converted to early total hip arthroplasty was 52 years compared to 38 years for the entire group. One patient had developed loss of fixation and required a second procedure. Other complications included DVT in 2.4% despite prophylaxsis with Warfarin and screening with duplex ultrasonography. There was one intraoperative pulmonary embolism from a pelvic DVT. Two patients (2.4%) had significant limitation in hip range of motion due to heterotopic ossification. Two patients (2.4%) had an iatrogenic sciatic nerve palsy despite intraoperative EMG monitoring, but none were permanent. There were no infections in this group of patients.

Discussion and Conclusion: The most common complication in this series of operatively treated acetabular fractures was conversion to total hip arthroplasty due to chondrolysis or an undetected femoral head fracture. Using a protocol to minimize the soft tissue complications associated with acetabular fractures including avoidance of extensile approaches, we were able to limit our failures to the extent of injury to the articular cartilage. We feel that chondrolysis is a significant early complication following operatively treated acetabular fractures. Further studies must be done to identify patients at risk for chondrolysis.