G Falzarano1, A Piscopo2, G Rollo3, A Medici1, P Grubor4, M Bisaccia5, V Pipola6, R Cioffi7, F Nobile8, L Meccariello9. 1. U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera Gaetano Rummo, Benevento, Italy. 2. U.O.C. Orthopedics and Traumatology, Hospital Sacro Cuore di Gesù Fatebenefratelli, Benevento, Italy. 3. Department of Orthopedics and Traumatology, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Via Ada Cudazzo, Block: A- Floor: V, Lecce, Italy. 4. Clinic of Traumatology, University Hospital Clinical Center, Banja Luka, Bosnia and Herzegovina. 5. Division of Orthopedics and Trauma Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy. 6. Rizzoli Orthopedic Institute, Bologna, Italy. 7. Division of Orthopedics and Trauma Surgery, University of L'Aquila, L'Aquila, Italy. 8. U.O.C. Orthopedics and Traumatology, Hospital Santa Maria alla Gruccia, Montevarchi, Arezzo, Italy. 9. Department of Orthopedics and Traumatology, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Via Ada Cudazzo, Block: A- Floor: V, Lecce, Italy. drlordmec@gmail.com.
Abstract
PURPOSE: Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD: We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT: Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION: Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.
PURPOSE: Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD: We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT: Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION: Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.
Entities:
Keywords:
Acetabular periprosthetic fractures; Bone loss; Hip revision surgery; Outcomes; Paprosky acetabular classification; Tantalum