Acetabulum Cup Stability in an Early Weight-Bearing Cadaveric Model of Geriatric Posterior Wall Fractures.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
pubmed:
23
8
2019
medline:
22
6
2021
entrez:
23
8
2019
Statut:
ppublish
Résumé
Primary total hip arthroplasty (THA) has been suggested for posterior wall (PW) fractures with unfavorable features in the geriatric population. There is a paucity of studies reporting on postoperative protocols for primary THA after PW fractures. The purpose of this study was to test the biomechanical effect of immediate assisted weight-bearing on acetabulum THA cup fixation in an osteoporotic PW fracture model. Computed tomography scans of 18 geriatric PW fractures (mean age, 77 ± 8 years) were used to generate representative PW fracture. This fracture pattern, comprising 50% of the PW and 25% of the acetabulum rim, was then created in 6 female cadaveric pelves. A multihole acetabulum THA cup was implanted with line-to-line reaming and fixed with four 5-mm screws. The pelves were cyclically loaded to up to 1.8× body weight (BW) in the intact form, after fracture creation and fracture fixation. Optical markers were used to determine acceptable cup motion of less than 150 μm. Five specimens withstood 3.6× BW loading after implantation and before fracture creation. At 1.8× BW load, cup motion was nonfractured: 50 ± 24 µm (range, 5-128 µm), fractured with no fixation: 37 ± 22 µm (range, 8-74 µm), or fractured with fixation: 62 ± 39 µm (range, 5-120 µm) (P = 0.0097). Cup motion was <150 µm for all groups. This study supports the practice of allowing immediate assisted weight-bearing in patients undergoing THA with PW fractures involving up to 50% of the PW and up to 25% of the acetabular rim, with or without fixation of the PW fragment.
Sections du résumé
BACKGROUND
BACKGROUND
Primary total hip arthroplasty (THA) has been suggested for posterior wall (PW) fractures with unfavorable features in the geriatric population. There is a paucity of studies reporting on postoperative protocols for primary THA after PW fractures. The purpose of this study was to test the biomechanical effect of immediate assisted weight-bearing on acetabulum THA cup fixation in an osteoporotic PW fracture model.
METHODS
METHODS
Computed tomography scans of 18 geriatric PW fractures (mean age, 77 ± 8 years) were used to generate representative PW fracture. This fracture pattern, comprising 50% of the PW and 25% of the acetabulum rim, was then created in 6 female cadaveric pelves. A multihole acetabulum THA cup was implanted with line-to-line reaming and fixed with four 5-mm screws. The pelves were cyclically loaded to up to 1.8× body weight (BW) in the intact form, after fracture creation and fracture fixation. Optical markers were used to determine acceptable cup motion of less than 150 μm.
RESULTS
RESULTS
Five specimens withstood 3.6× BW loading after implantation and before fracture creation. At 1.8× BW load, cup motion was nonfractured: 50 ± 24 µm (range, 5-128 µm), fractured with no fixation: 37 ± 22 µm (range, 8-74 µm), or fractured with fixation: 62 ± 39 µm (range, 5-120 µm) (P = 0.0097). Cup motion was <150 µm for all groups.
CONCLUSION
CONCLUSIONS
This study supports the practice of allowing immediate assisted weight-bearing in patients undergoing THA with PW fractures involving up to 50% of the PW and up to 25% of the acetabular rim, with or without fixation of the PW fragment.
Identifiants
pubmed: 31436615
doi: 10.1097/BOT.0000000000001627
pii: 00005131-202001000-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
55-61Références
Ochs BG, Marintschev I, Hoyer H, et al. Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German pelvic multicentre study group (DAO/DGU). Injury. 2010;41:839–851.
Kim J, Herbert B, Hao J, et al. Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries. Int Orthop. 2015;39:1175–1179.
Manson T, Schmidt AH. Acetabular fractures in the elderly: a critical analysis review. JBJS Rev. 2016;4:1–14.
Aho AJ, Isberg UK, Katevuo VK. Acetabular posterior wall fracture. 38 cases followed for 5 years. Acta Orthop Scand. 1986;57:101–105.
Baumgaertner MR. Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg. 1999;7:54–65.
Letournel E, Judet R. Fractures of the Acetabulum. In: Elson RA, ed and translator. New York, NY: Springer; 1993:29–43, 364–73, 417–21, 545–51, 565–81, 583–90.
Li H, Yang H, Wang D, et al. Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates. Injury. 2014;45:709–714.
Miller AN, Prasarn ML, Lorich DG, et al. The radiological evaluation of acetabular fractures in the elderly. J Bone Joint Surg Br. 2010;92:560–564.
Butterwick D, Papp S, Gofton W, et al. Acetabular fractures in the elderly: evaluation and management. J Bone Joint Surg Am. 2015;97:758–768.
Moed BR, Carr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am. 2002;84:752–758.
Saterbak AM, Marsh JL, Nepola JV, et al. Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma. 2000;14:230–237.
Bhandari M, Matta J, Ferguson T, et al. Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg Br. 2006;88:1618–1624.
Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012;94:1559–1567.
Ferguson TA, Patel R, Bhandari M, et al. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92:250–257.
Kreder HJ, Rozen N, Borkhoff CM, et al. Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg Br. 2006;88:776–782.
Wu ES, Jauregui JJ, Banerjee S, et al. Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture. Expert Rev Med Devices. 2015;12:297–306.
Boelch SP, Jordan MC, Meffert RH, et al. Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int Orthop. 2017;41:1831–1837.
Archdeacon M, Kazemi N, Collinge C, et al. Treatment of protrusio fractures of the acetabulum in patients 70 years and older. J Orthop Trauma. 2013;27:256–261.
Oh C, Kim P, Park B, et al. Results after operative treatment of transverse acetabular fractures. J Orthop Sci. 2006;11:478–484.
Liu X, Xu S, Zhang C, et al. Application of a shape- memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop. 2010;34:1033–1040.
Mears DC, Velyvis JH. Primary total hip arthroplasty after acetabular fracture. Instr Course Lect. 2001;50:335–354. Review.
Sermon A, Broos P, Vanderschot P. Total hip replacement for acetabular fractures: results in 121 patients operated between 1983 and 2003. Injury. 2008;39:914–921.
Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: 2—12-year results. J Bone Joint Surg Am. 2002;84-A:1–9.
Kelly PJ, Lipscomb PR. Primary Vitallium-mold arthroplasty for posterior dislocation of the hip with fracture of the femoral head. J Bone Joint Surg Am. 1958;40-A:675.
Daurka JS, Pastides PS, Lewis A, et al. Acetabular fractures in patients aged >55 years: a systematic review of the literature. Bone Joint J. 2014;96-B:157–163.
Salama W, Mousa S, Khalefa A, et al. Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures. Int Orthop. 2017;41:181–189.
Sierra RJ, Mabry TM, Sems SA, et al. Acetabular fractures: the role of total hip replacement. Bone Joint J. 2013;95(11 suppl A):11–16.
Malhotra R, Singh DP, Jain V, et al. Acute total hip arthroplasty in acetabular fractures in the elderly using the Octopus System: mid term to long term follow-up. J Arthroplasty. 2013;28:1005–1009.
Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–871.
Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res. 1986;208:108–113.
Engh CA, O'connor D, Jasty M, et al. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res. 1992;285:13–29.
Hofmann AA, Bloebaum RD, Bachus KN. Progression of human bone ingrowth into porous-coated implants. Rate of bone ingrowth in humans. Acta Orthop Scand. 1997;68:161–166.
Damm P, Schwachmeyer V, Dymke J, et al. In vivo hip joint loads during three methods of walking with forearm crutches. Clin Biomech. 2013;28:530–535.
Tornetta P III. Non-operative management of acetabular fractures. The use of dynamic stress views. J Bone Joint Surg Br. 1999;81:67–70.
Keith JE Jr, Brashear HR Jr, Guilford WB. Stability of posterior fracture- dislocations of the hip. Quantitative assessment using computed tomog- raphy. J Bone Joint Surg Am. 1988;70:711–714.
Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum. J Orthop Trauma. 2009;23:7–15.
Firoozabadi R, Spitler C, Schlepp C, et al. Determining stability in posterior wall acetabular fractures. J Orthop Trauma. 2015;29:465–469.
Marmor M, McDonald E, Buckley JM, et al. Propensity for hip dislocation in normal gait loading versus sit-to-stand maneuvers in posterior wall acetabular fractures. Am J Orthop. 2013;42:412–415.
Boraiah S, Ragsdale M, Achor T, et al. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma. 2009;23:243–248.
Rickman M, Young J, Trompeter A, et al. Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weight bearing. Clin Orthop Relat Res. 2014;472:3375–82.
Boscainos PJ, Kellett CF, Maury AC, Backstein D, Gross AE. Management of periacetabular bone loss in revision hip arthroplasty. Clin Orthop Relat Res. 2007;465:159–165.
Lakstein D, Backstein D, Safir O, et al. Trabecular Metal™ Cups for acetabular defects with 50% or less host bone contact. Clin Orthop Relat Res. 2009;467:2318–2324.
Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9:33–44.