Analysis Of The Clinical Results In Total Hip Arthroplasty And Hip Resurfacing Arthroplasty For Posttraumatic Arthritis After Operative Treatment Of Acetabular Fractures

Objective:To analysis the clinical results in total hip arthroplasty(THA) and total hip resurfacing arthroplasty(HRA) for posttraumatic arthritis secondary to open reduction and internal fixation(ORIF) of acetabular fractures and, in addition, discuss the prevention of postoperative complications in internal fixation of acetabular fractures and the issues related with operation in hip arthroplasty.Method:From August 2004 to August 2009, 23 total hip arthroplasties and 7 total hip resurfacing arthroplasties were performed in our department for posttraumatic arthritis secondary to acetabular fractures. The average period from fracture to arthroplasty was 47 months(3～144months). The average age at arthroplasty was 41.5±8.4 years(26～67years). According to Letournel-Judet system, these cases were classified as simple fracture patterns in 9, associated fracture patterns in 21. According to AAOS classification, acetabular bone stock deficiencies were found in 16 cases. Clinical results were evaluated by Harris hip score and radiographic results were analyzed by postoperative serial X-ray films.Result:All patients were followed up for an average period of 36.7 months(6～66 months). Harris Hip score increased from 44.2±12.4 to 89.1±7.1 points at the latest follow-up, and the excellent and good rate was 90%. There were significant statistical differences between preoperative and postoperative Harris score(P<0.01). 23 total hip arthroplasties were followed up for an average period of 41.5 months(6～66 months). Harris Hip score increased from 45.5±13.6 to 88.5±7.8 points at the latest follow-up, and the excellent and good rate was 87%. 7 total hip resurfacing arthroplasties were followed up for an average period of 20.9 months(8～35 months). Harris Hip score increased from 39.7±6.0 to 90.9±4.3 points at the latest follow-up, and the excellent and good rate was 100%. A partial radiolucent line was seen in two cementless acetabular cup and one cemented cup without signs of prosthesis subsidence or migration in total hip arthroplasty. The prosthesis was no radiolucent lines and signs of subsidence or migration in total hip resurfacing arthroplasty. The results revealed that there were no postoperative infections, hip dislocation, significant heterotopic ossification occurred, blood vessel or nerve injury in the follow-ups. Furthermore there was no patient with cup or stem revised.Conclusion:Open reduction and internal fixation of an acetabular fracture must ensure anatomic reduction and fixation, and try to avoid the occurrence of traumatic arthritis. Although in the most of posttraumatic arthritis secondary to open reduction and internal fixation of acetabular fractures increases the difficulty of operative treatment, it can achieve a fine clinical result with Total hip arthroplasty by careful surgical plans, sufficient bone grafts and correct choice different type prostheses. There are certain advantages for some patients who are fit for the conditions with total hip resurfacing arthroplasties. However, the long-term efficacy needs further follow-up.