Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients.

OBJECTIVES

To investigate the clinical and functional outcome in an elderly population with acetabular fractures after low-energy trauma treated acutely with a total hip arthroplasty supported by a reinforcement ring (Burch-Schneider antiprotrusion cage) and autologous bone grafting of the acetabulum.

SETTING

University hospital.

DESIGN

Retrospective clinical study.

PATIENTS: Ten patients (7 males) available for follow-up, with a mean age at the time of surgery of 73 years (range 57-87). The mean time to follow-up was 38 months (range 11-84).

INTERVENTION: Primary total hip arthroplasty supported by a reinforcement ring (Burch-Schneider Antiprotrusion Cage) and autologous bone grafting of the acetabulum.

MAIN OUTCOME MEASUREMENTS: Surgical data, complications, radiographic assessment, pain, walking ability, Harris Hip Score, activities of daily living, health-related quality of life according to EuroQol (EQ-5D).

RESULTS

The mean operating time was 159 minutes (range 125-185). The mean intraoperative blood loss was 1100 mL (700-1600 mL). The reinforcement ring was stable and there were no signs of loosening of the acetabular component or stem in any of the patients. The bone graft was completely incorporated in all cases. Four patients presented slight (Brooker I-II) heterotopic bone formation. All patients were still independent walkers at follow-up but with a slightly increased need for walking aids. The mean Harris Hip Score was 85 (range 69-99). The mean EQ-5D(index) score was 0.62.

CONCLUSION

Primary total hip replacement with a reinforcement ring and bone grafting of the socket seems to be a promising treatment alternative in displaced acetabular fractures in elderly patients with osteoporotic bone, except in those with an increased risk of dislocation.