Top

Current Reviews in Musculoskeletal Medicine

Published in:

01-12-2013 | Modern Concepts in Primary and Revision Total Hip Arthroplasty (TN Board, Section editor)

Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum

Authors: Amol Chitre, Henry Wynn Jones, Nikhil Shah, Anthony Clayson

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2013

Abstract

Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components. This article explores the current literature on the epidemiology, etiology, and classification of periprosthetic acetabular fractures as well as offering potential treatment strategies.

• Kim YS, Callaghan JJ, Ahn PB, et al. Fracture of the acetabulum during insertion of an oversized hemispherical component. J Bone Joint Surg Am. 1995;77:111–7. Cadaveric study showing that under-reaming by more than 2 mm when impacting a hemispherical cup can increase the chance of acetabular fracture during component insertion.PubMed

• Sharkey PF, Hozack WJ, Callaghan JJ, et al. Acetabular fractures associated with cementless acetabular component insertion: a report of 13 cases. J Arthroplasty. 1999;14:426–31. Case series of 13 patients with acute periprosthetic fractures of the acetabulum. They suggest that if found intraoperatively and stable, a screw may be sufficient to stabilize the implant. If found post-operatively conservative management with restricted weight bearing was sufficient to allow union to occur, although patient reported satisfaction in such patients was poorer despite clinical and radiographic fracture union.PubMedCrossRef

Curtis MJ, Jinnah RH, Wilson VD, et al. The initial stability of uncemented acetabular components. J Bone Joint Surg Br. 1992;74:372–6.PubMed

•• Haidukewych GJ, Jacofsky DJ, Hansen AD, et al. Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am. 2006;88–A:1952–56. This is the largest reported series to look specifically at intraoperative acetabular fractures. They show a prevalence of 0.4% in uncemented components, whilst demonstrating a significant difference in rates depending on type of shell (elliptical higher then hemispherical).

Takigami I, Ito Y, Mizoguchi T, et al. Pelvic discontinuity caused by acetabular over-reaming during primary total hip arthroplasty. Case Reports in Orthopaedics. 2011. Article ID 939202.

Zwartele RE, Witjes S, Doets HC, et al. Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature. Arch Orthop Trauma Surg. 2012;132:535–46.PubMedCrossRef

McGrory BJ. Periprosthetic fracture of the acetabulum during total hip arthroplasty in a patient with Pagets disease. Am J Orthop. 1999;28:248–50.PubMed

Desai G, Ries MD. Early postoperative acetabular discontinuity after total hip arthroplasty. J Arthroplasty. 2011;26:1570. e17–9. [Epub 2011 Mar 2]. doi: 10.1016/j.arth.2010.12.021.

Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1206.PubMed

10.

Miller AJ. Late fracture of the acetabulum after total hip replacement. J Bone Joint Surg Br. 1972;54:483.

11.

Cooper RA, McAllister CM, Borden LS, et al. Polyethylene debris-induced osteolysis and loosening in uncemented total hip arthroplasty: a cause of late failure. J Arthroplasty. 1992;7:285.PubMedCrossRef

12.

Schmalzreid TP, Jasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty: polyethylene wear debris and the concept of effective joint space. J Bone Joint Surg Am. 1992;74:849.

13.

Maloney WJ, Peters P, Engh CA, et al. Severe osteolysis of the pelvis in association with acetabular replacement without cement. J Bone Joint Surg Am. 1993;75:1627.PubMed

14.

Chattoo M, Parfitt J, Pearse MF. Periprosthetic acetabular fracture associated with extensive osteolysis. J Arthroplasty. 1998;13:843–5.CrossRef

15.

Sanchez-Sotelo J, McGrory BJ, Berry DJ. Acute periprosthetic fracture of the acetabulum associated with osteolytic pelvic lesions: a report of 3 cases. J Arthroplasty. 2000;15:126–30.PubMedCrossRef

16.

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.PubMed

17.

Bradford MS, Paprosky WG. Acetabular defect classification: a detailed radiographic approach. Semin Arthroplasty. 1995;6:76–85.PubMed

18.

Davidson D, Pike J, Garbuz D, et al. Intraoperative periprosthetic fractures during total hip arthroplasty. J Bone Joint Surg. 2008;90:2000–12.PubMedCrossRef

19.

Springer BD, Berry DJ, Cabalena ME, et al. Early postoperative transverse pelvic fracture: a new complication related to revision arthroplasty with an uncemented cup. J Bone Joint Surg Am. 2005;87:2626–31.PubMedCrossRef

20.

Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1692–702.PubMed

21.

•• 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. Largest series following results of reconstructing pelvic discontinuities with either posterior column plating or cup = cage reconstruction. They suggest using posterior column plating in acute instability, whilst a cup-cage construct in patients with chronic stiff discontinuities.PubMedCrossRef

22.

Parikh SN, Kreder HJ. Pelvic reconstruction for massive acetabular insufficiency. Clin Orthop Relat Res. 2005;434:217–21.PubMedCrossRef

23.

Eggli S, Muller C, Ganz R. Revision surgery in pelvic discontinuity: an analysis of seven patients. Clin Orthop Relat Res. 2002;398:136–45.PubMedCrossRef

24.

Gililland JM, Anderson LA, Henninger HB, Kubiak EN, Peters CL. Biomechanical analysis of acetabular revision constructs: is pelvic discontinuity best treated with bicolumnar or traditional unicolumnar fixation? J Arthroplasty. 2013;28:176–86.CrossRef

25.

National Joint Registry for England and Wales. 9th Annual Report. 2012 ISSN 1745–1450.

26.

Schreurs BW, Zengerink M, Welten ML, van Kampen A, Slooff TJ. Bone impaction grafting and a cemented cup after acetabular fracture at 3–18 years. Clin Orthop Relat Res. 2005;437:145–51.PubMedCrossRef

27.

Kosashvili Y, Backstein D, Safir O, Lakstein D, Gross AE. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg Br. 2009;91:870–6.PubMed

Title: Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum
Authors: Amol Chitre
Henry Wynn Jones
Nikhil Shah
Anthony Clayson
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 4/2013
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-013-9188-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Achilles tendon ruptures

Dislocation after total hip arthroplasty

Total ankle arthroplasty in end-stage ankle arthritis

Approach and treatment of the adult acquired flatfoot deformity

Syndesmosis injuries of the ankle

Syndesmosis injuries