Abe Elizabeth A, Frenz Brian J, Sutton Ryan M, Fraval Andrew, Krueger Chad A, Courtney P Maxwell
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2024 Nov 30. doi: 10.1016/j.arth.2024.11.050.
Acute pelvic discontinuity (PD) is a rare, yet challenging complication following total hip arthroplasty (THA). Although several techniques, such as plating of the posterior column and spanning of the discontinuity with a cup cage, have been described for the management of acute PD, few studies have determined the survivorship of acetabular constructs in this setting. The purpose of this study was to determine the outcomes of acetabular fixation of the posterior column in patients who had acute PD following THA.
We reviewed a consecutive series of 24 patients diagnosed with acute PD at a single institution from 2018 to 2022. All patients were managed with open reduction and internal fixation of the discontinuity with a posterior column plate and highly porous cup. The primary outcome was acetabular component survivorship using Kaplan-Meier analysis. Secondary outcomes included rates of radiographic union of the fracture, aseptic loosening, dislocation, and infection.
There were 17 women and seven men who had a mean age of 73 years (range, 50 to 89) included in the analysis. At 3.5 years of (range, 1.0 to 6.2) follow-up, implant survivorship free from aseptic acetabular failure was 91.7% upon Kaplan-Meier analysis. There was one patient who underwent acetabular rerevision secondary to component loosening in the early postoperative period, while one patient had radiographic evidence of acetabular cup loosening at 1-year follow-up. No other revision procedures, periprosthetic fractures, prosthetic dislocations, or nerve injuries were reported. The overall complication rate was 20.8%. There were three patients who required irrigation and debridement, while two patients experienced medical complications.
Posterior column plating with a highly porous acetabular cup can be a reliable treatment option for the management of acute PD. However, future studies with longer follow-ups comparing implant survivorship between posterior column plating and cup-cage constructs are necessary.
急性骨盆不连续（PD）是全髋关节置换术（THA）后一种罕见但具有挑战性的并发症。尽管已经描述了几种技术，如后柱钢板固定和使用髋臼笼跨越不连续处，用于处理急性PD，但很少有研究确定在这种情况下髋臼结构的生存率。本研究的目的是确定THA后发生急性PD患者后柱髋臼固定的结果。
我们回顾了2018年至2022年在单一机构连续诊断为急性PD的24例患者。所有患者均接受切开复位，并用后柱钢板和高度多孔髋臼杯进行不连续处的内固定。主要结局是使用Kaplan-Meier分析的髋臼组件生存率。次要结局包括骨折的影像学愈合率、无菌性松动、脱位和感染率。
分析纳入了17名女性和7名男性，平均年龄73岁（范围50至89岁）。在平均3.5年（范围1.0至6.2年）的随访中，经Kaplan-Meier分析，无无菌性髋臼失败的植入物生存率为91.7%。有1例患者在术后早期因组件松动接受了髋臼翻修，而1例患者在1年随访时有髋臼杯松动的影像学证据。未报告其他翻修手术、假体周围骨折、假体脱位或神经损伤。总体并发症发生率为20.8%。有3例患者需要冲洗和清创，2例患者出现医疗并发症。
后柱钢板联合高度多孔髋臼杯可作为治疗急性PD的可靠选择。然而，有必要进行未来更长随访期的研究，比较后柱钢板固定和髋臼笼结构之间的植入物生存率。
