Contemporary acetabular fracture surgery: treading water or swimming upstream?

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Abstract

[Indexed for MEDLINE] 19. Orthop Traumatol Surg Res. 2024 Sep;110(5):103914. doi: 10.1016/j.otsr.2024.103914. Epub 2024 Jun 8. Functional outcomes and center of rotation restoration in total hip arthroplasty after acetabular fracture: A review of 367 hips. Tonetti J(1), Riouallon G(2), Martz P(3), de Dompsure RB(4), Erivan R(5), Guignard A(6), Tiercelin J(7), Schmitz A(8), Belvisi B(9), Moreau PE(10), Binheng K(11), Bengana A(11), Boudissa M(11), Reina N(6). Author information: (1)Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France. Electronic address: jtonetti@chu-grenoble.fr. (2)Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris-St-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. (3)Service de chirurgie orthopédique et traumatologie, hôpital François-Mitterrand, 2, boulevard Mar-de-Lattre-de-Tassigny, 21000 Dijon, France. (4)Service de chirurgie orthopédique et traumatologie, hôpital Pasteur, 30, voie Romaine, 69, 06001 Nice cedex 1, France. (5)Service de chirurgie orthopédique et traumatologie hôpital Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France. (6)Service de chirurgie orthopédique et traumatologie, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France. (7)Service de chirurgie orthopédique et traumatologie, hôpital Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France. (8)Service de chirurgie orthopédique et traumatologie, hôpital Central, 29, avenue Mar-de-Lattre-de-Tassigny, 54000 Nancy, France. (9)Service de chirurgie orthopédique et traumatologie, hôpital Annecy-Genevois, 1, avenue de lHôpital, 74370 Epagny Metz-Tessy, France. (10)Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris-St Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. (11)Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France. BACKGROUND: Total hip arthroplasty (THA) after acetabular fracture is typically performed months or years later for posttraumatic arthritis after initial conservative treatment. But THA can be performed earlier after open reduction and internal fixation (ORIF) of the fracture. The aim of this study was to determine which strategy is best. The primary outcome measure was the radiological restoration of the hip's center of rotation (COR). The secondary outcome measures were the incidence of complications and the hip's functional scores. MATERIALS AND METHODS: A multicenter cohort was analyzed by splitting patients into three groups: group A (THA within 3weeks of fracture); group B (THA deferred after early ORIF); group C (THA more than 3weeks after fracture, without ORIF). Group B was separated into two subgroups: B- (THA less than 1year after ORIF) and B+ (THA more than 1year after ORIF). The demographics, surgical techniques, COR superior and lateral migration coefficient and functional scores (HHS, HOOS-PS and FJS) were recorded. The functional scores were gathered using PROMs. RESULTS: In all, 367 patients were included: 108 in group A, 69 in group B-, 113 in group B+ and 77 in group C. The mean follow-up was 5.8years [3.4 months-35years]. The mean age of the patients was 69.2years [SD 15; 26-101], 52years [SD 16; 19-83], 49years [SD 16; 16-85] and 58.1years [SD 17; 13-94], respectively (p