Abrahams John M, Ramasamy Boopalan, Dong Xiangyu, Chou Daud Tai Shan, Costi Kerry, Solomon Lucian Bogdan, Callary Stuart Adam
Centre for Orthopaedic and Trauma Research, Adelaide University, Adelaide, Australia.
Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.
Bone Jt Open. 2025 Oct 17;6(10):1282-1294. doi: 10.1302/2633-1462.610.BJO-2025-0025.R1.
The aim of this study was to determine the early stability of acetabular components of total hip arthroplasty (THA) treating acute acetabular fractures through a replace-in-situ technique, using standard radiological assessment techniques as well as radiostereometric analysis (RSA), the gold standard for assessment of implant stability.
We prospectively investigated 29 patients who underwent THA to manage an acute acetabular fracture in which patients underwent postoperative in-clinic radiological assessment of acetabular component stability, and detailed measurements using both RSA and manual techniques. The latter were performed based on pelvic reference landmarks located below and above the fracture. Greater than 3 mm of proximal translation and/or 5° of rotation around the sagittal axis were considered diagnostic of a loose acetabular component.
The median proximal translation and sagittal rotation of the cohort was 0.5 mm (IQR 0.3 to 0.9) and 0.8° (IQR -0.6° to 1.1°), respectively, as measured by RSA at two years. Acetabular components in the most unstable acetabular fracture patterns were found to migrate more immediately post-surgery. There was a disparity between different measurement techniques. Accurate RSA measurements correctly identified two components that were deemed to be clinically loose, and the diagnostic performance of RSA migration measurements was improved when migration within the first six months was excluded. Visual assessment of radiographs in clinic underestimated - and manual radiological measurements overestimated - acetabular component loosening in these complex cases.
The replace-in-situ technique led to acceptable early acetabular component stability in the majority of cases (27/29, 93%), a good result considering the complexity of these reconstructions. Accurate measurements of acetabular component migration are recommended in these cases, as pelvic landmark identification on consecutive plain radiographs is influenced by both pelvic projection on plain radiographs and fracture fragment migration during healing.
本研究旨在通过原位置换技术治疗急性髋臼骨折的全髋关节置换术（THA）中，使用标准放射学评估技术以及放射立体测量分析（RSA，评估植入物稳定性的金标准）来确定髋臼组件的早期稳定性。
我们前瞻性地研究了29例行THA治疗急性髋臼骨折的患者，患者术后在门诊接受髋臼组件稳定性的放射学评估，并使用RSA和手动技术进行详细测量。后者是基于骨折上下方的骨盆参考标志进行的。近端移位大于3 mm和/或绕矢状轴旋转5°被认为可诊断髋臼组件松动。
通过RSA在两年时测量，该队列的中位近端移位和矢状面旋转分别为0.5 mm（四分位间距0.3至0.9）和0.8°（四分位间距-0.6°至1.1°）。发现最不稳定的髋臼骨折类型中的髋臼组件在术后立即移位更多。不同测量技术之间存在差异。准确的RSA测量正确识别出两个临床上被认为松动的组件，并且排除前六个月内的移位后，RSA移位测量的诊断性能得到改善。在这些复杂病例中，临床X线片的视觉评估低估了髋臼组件松动，而手动放射学测量则高估了髋臼组件松动。
原位置换技术在大多数病例（27/29，93%）中导致了可接受的早期髋臼组件稳定性，考虑到这些重建的复杂性，这是一个良好的结果。在这些病例中，建议准确测量髋臼组件的移位，因为连续平片上骨盆标志的识别受平片上骨盆投影和愈合过程中骨折碎片移位的影响。
