Acetabular fractures, Fracturas acetabulares / The role of total hip replacement / El papel de la artroplastia total de cadera

FUENTE ORIGINAL DEL ARTÍCULO:

http://www.bjj.boneandjoint.org.uk/content/95-B/11_Supple_A/11.abstract

Acetabular fractures

The role of total hip replacement

1. R. J. Sierra, MD, Associate Professor1;
2. T. M. Mabry, MD, Assistant Professor1;
3. S. A. Sems, MD, Assistant Professor1; and
4. D. J. Berry, MD, Professor of Orthopaedics1

+ Author Affiliations

1. ¹Mayo Clinic, Department of Orthopaedic Surgery, 200 First St, SW, Rochester, Minnesota 55905, USA.

1. Correspondence should be sent to Dr R. J. Sierra; e-mail:sierra.rafael@mayo.edu

Abstract

Total hip replacement (THR) after acetabular fracture presents unique challenges to the orthopaedic surgeon. The majority of patients can be treated with a standard THR, resulting in a very reasonable outcome. Technical challenges however include infection, residual pelvic deformity, acetabular bone loss with ununited fractures, osteonecrosis of bone fragments, retained metalwork, heterotopic ossification, dealing with the sciatic nerve, and the difficulties of obtaining long-term acetabular component fixation. Indications for an acute THR include young patients with both femoral head and acetabular involvement with severe comminution that cannot be reconstructed, and the elderly, with severe bony comminution. The outcomes of THR for established post-traumatic arthritis include excellent pain relief and functional improvements. The use of modern implants and alternative bearing surfaces should improve outcomes further.

Cite this article: Bone Joint J 2013;95-B, Supple A:11–16.

Fracturas acetabulares

El papel de la artroplastia total de cadera

Resumen

El reemplazo total de la cadera (THR) después de la fractura acetabular presenta desafíos únicos para el cirujano ortopédico. La mayoría de los pacientes puede ser tratada con un THR estándar, lo que resulta en un resultado muy razonable. Los desafíos técnicos sin embargo incluyen infección, deformidad pélvica residual, la pérdida ósea acetabular con fracturas ununited, la osteonecrosis de los fragmentos de hueso, metal retenido, osificación heterotópica, tratar con el nervio ciático, y las dificultades para obtener la fijación componente acetabular a largo plazo. Las indicaciones para un THR aguda incluyen pacientes jóvenes con tanto cabeza femoral y acetabular implicación con conminución grave que no puede ser reconstruido, y los ancianos, con trituración ósea severa. Los resultados de la THR para la artritis post-traumática estableció incluyen excelente alivio del dolor y mejoras funcionales. El uso de implantes modernos y superficies de apoyo alternativos debería mejorar los resultados aún más.

Footnotes

• No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This paper is based on a study which was presented at the 29th Annual Winter 2012 Current Concepts in Joint Replacement^® meeting held in Orlando, Florida, 12th – 15th December.

• Received September 5, 2013.
• Accepted September 6, 2013.

• ©2013 The British Editorial Society of Bone & Joint Surgery