Intraoperative Acetabular Fracture

Abstract

Intraoperative acetabular fracture is a rare complication in total hip arthroplasty. It occurs mainly as a result of impaction of a cementless press-fit cup. Risk factors include decreased bone quality, highly sclerotic bone, and a press-fit that was relatively too large. The timing of the diagnosis determines the therapeutic approach. Fractures detected intraoperatively should be treated with appropriate stabilisation. Postoperatively, the stability of the implants as well as the fracture pattern determine whether a conservative treatment is initially feasible. Most acetabular fractures diagnosed intraoperatively are to be treated with a multi-hole cup, with additional screws anchoring in the different acetabular regions. In cases of large posterior wall fragments or pelvic discontinuity, plate osteosynthesis of the posterior column is indicated. Alternatively, cup-cage reconstruction can be utilised. Especially in elderly patients, the therapeutic goal must be rapid mobilisation through adequate primary stability, in order to minimise the risk of complications, revision, and mortality.

Keywords

total hip arthroplasty - complications - intraoperative acetabular fracture - periprosthetic fracture - cup revision

Publication History

Received: 14 November 2022

Accepted: 14 December 2022

Article published online:
02 March 2023

• Literatur

• 1 Haidukewych GJ, Jacofsky DJ, Hanssen AD. et al. Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am 2006; 88: 1952-1956 DOI: 10.2106/JBJS.E.00890. (PMID: 16951110)
• 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: 426-431 DOI: 10.1016/S0883-5403(99)90097-9. (PMID: 10428222)
• 3 Kim YS, Callaghan J, Ahn PB. et al. Fracture of the acetabulum during insertion of an oversized hemispherical component. J Bone Joint Surg Am 1995; 77: 111-117 DOI: 10.2106/00004623-199501000-00013. (PMID: 7822342)
• 4 Brown JM, Borchard KS, Robbins CE. et al. Management and Prevention of Intraoperative Acetabular Fracture in Primary Total Hip Arthroplasty. Am J Orthop (Belle Mead NJ) 2017; 46: 232-237 (PMID: 29099882)
• 5 Laflamme GY, Belzile EL, Fernandes JC. et al. Periprosthetic fractures of the acetabulum during cup insertion: Posterior column stability is crucial. J Arthroplasty 2015; 30: 265-269 DOI: 10.1016/j.arth.2014.09.013. (PMID: 25307882)
• 6 Desai G, Ries MD. Early Postoperative Acetabular Discontinuity After Total Hip Arthroplasty. Arthroplasty 2011; 26: 1570.e17-1570.e19 DOI: 10.1016/j.arth.2010.12.021. (PMID: 21371857)
• 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: 1583-1590 DOI: 10.1007/s00264-018-4084-7. (PMID: 30097730)
• 8 Hasegawa K, Kabata T, Kajino Y. et al. Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA. Clin Orthop Relat Res 2017; 475: 484-494 DOI: 10.1007/s11999-016-5138-z. (PMID: 27800574)
• 9 Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 1996; 78: 1206-1213 DOI: 10.2106/00004623-199608000-00011. (PMID: 8753713)
• 10 Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res 1980; (151) 81-106 DOI: 10.1055/s-2007-980136. (PMID: 7418327)
• 11 Callaghan JJ. Periprosthetic fractures of the acetabulum during and following total hip arthroplasty. Instr Course Lect 1998; 47: 231-235 (PMID: 9571423)
• 12 Della Valle CJ, Momberger NG, Paprosky WG. Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 2003; 52: 281-290 (PMID: 12690856)
• 13 Pascarella R, Sangiovanni P, Cerbasi S. et al. Periprosthetic acetabular fractures: A New classification proposal. Injury 2018; 49 (Suppl. 03) S65-S73 DOI: 10.1016/j.injury.2018.09.061. (PMID: 30415671)
• 14 Duncan CP, Haddad FS. The Unified Classification System (UCS): Improving our understanding of periprosthetic fractures. Bone Joint J 2014; 96-B: 713-716 DOI: 10.1302/0301-620X.96B6.34040. (PMID: 24891568)
• 15 Yamamuro Y, Kabata T, Kajino Y. et al. Does intraoperative periprosthetic occult fracture of the acetabulum affect clinical outcomes after primary total hip arthroplasty?. Arch Orthop Trauma Surg 2022; 142: 3497-3504 DOI: 10.1007/s00402-021-04226-y. (PMID: 34677634)
• 16 Rogers BA, Whittingham-Jones PM, Mitchell PA. et al. The reconstruction of periprosthetic pelvic discontinuity. J Arthroplasty 2012; 27: 1499-1506.e1 DOI: 10.1016/j.arth.2011.12.017. (PMID: 22325964)
• 17 Takigami I, Ito Y, Mizoguchi T. et al. Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty. Case Rep Orthop 2011; 2011: 939202 DOI: 10.1155/2011/939202. (PMID: 23259104)
• 18 Lin C, Caron J, Schmidt AH. et al. Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma 2015; 29: 151-159 DOI: 10.1097/BOT.0000000000000164. (PMID: 24978942)
• 19 De Bellis UG, Legnani C, Calori GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury 2014; 45: 356-361 DOI: 10.1016/j.injury.2013.09.018. (PMID: 24112700)
• 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: 478-483 DOI: 10.1302/0301-620X.101B4.BJJ-2018-1027.R2. (PMID: 30929478)
• 21 Konan S, Duncan CP, Masri BA. et al. The cup-cage reconstruction for pelvic discontinuity has encouraging patient satisfaction and functional outcome at median 6-year follow-up. Hip Int 2017; 27: 509-513 DOI: 10.5301/hipint.5000480. (PMID: 28165588)
• 22 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 DOI: 10.1302/0301-620X.96B2.31907. (PMID: 24493184)
• 23 Hipfl C, Janz V, Löchel J. et al. 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: 1442-1448 DOI: 10.1302/0301-620X.100B11.BJJ-2018-0481.R1. (PMID: 30418066)