Use of Dual-Mobility Cups Reduce Dislocation Risk After Internal Fixation for Acetabular Fracture Concomitant With Total Hip Arthroplasty in Patients Who Are over 60 Years Old.

BACKGROUND

Treatment of complex acetabular fractures in patients over 60 remains challenging. Functional treatments for these fractures have yielded disappointing outcomes. Internal fixation may fail facing this porotic bone, and postoperative non-weight-bearing may expose the patient to decubitus complications. Our hypothesis was that use of a dual-mobility cup (DMC) reduces dislocation risk after concomitant internal fixation and total hip arthroplasty (THA) for acetabular fracture in patients who are over 60 years old.

METHODS

A retrospective, observational noncomparative and continuous study was conducted from January 2015 to September 2022. Patients aged over 60 years who had displaced acetabular fractures, treated surgically via concomitant internal fixation and THA, using a DMC exclusively through the Kocher-Langenbeck approach and a minimum follow-up was of one year, were included. There were 45 patients (45 hips) who had an average age of 71 years (range, 60 to 88) who were included (75.5% men). The main mechanisms of injury were the motor vehicle accidents (in 21 cases (46.7%)). Bicolumn fractures were prevalent (46.6%). The analysis of complications included intraoperative nerve palsy, postoperative dislocations, deep infections, periprosthetic fractures, and loosening. Clinical assessment included the Harris hip score and the level of return to previous activities. Radiological evaluation assessed fracture union, periprosthetic osteolysis, graft integration, the presence of leg length discrepancy and heterotopic ossification.

RESULTS

There was one case of dislocation (2.2%) requiring reoperation for replacement of the prosthetic neck, and one patient (2.2%) experienced early THA infection, successfully treated with surgical lavage and antibiotics. Functional outcomes showed a mean Harris hip score of 88 (range, 69 to 99) and 84% of patients resumed their previous activities. Radiological follow-up revealed no loosening.

CONCLUSIONS

This study has shown that the use of DMC in concomitant THA with open reduction and internal fixation for acetabular facture in patient over age 60 years achieved a low dislocation rate with favorable clinical and radiological outcomes and a low complication rate.