Outcomes of post-operative periprosthetic acetabular fracture around total hip arthroplasty

Abstract

Post-operative periprosthetic acetabular fractures are rare, but serious complication following total hip arthroplasty (THA). As the number of THA performed each year increases so will the expected number of periprosthetic fractures, thus making the treatment of these fractures an important topic for discussion. The purpose of this review is to analyze the recent evidence on risk factors, fracture classification schemes and treatment strategies that have been used for periprosthetic acetabular fractures around THA. The modified Paprosky classification is the most widely used and is a useful guide for management strategies. This classification system provides the guidelines for developing multiple treatment algorithms for decision making. Treatment options for surgical management include open reduction and internal fixation with plating, use of reconstruction cages, trabecular metal augments and bone grafting as needed. Treatment decisions are still an area of controversy and current research.

Keywords:

• acetabulum
• arthroplasty
• fracture
• hip
• periprosthetic
• post-operative

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Etiology is multifactorial, and considers patient-related factors and implant characteristics.

• The most widely used classification system is that of Paprosky, which can guide management.

• Type III fractures may occasionally be treated with restricted weight bearing if the component is stable.

• To determine the amount of native acetabular bone remaining, computerized tomography can be helpful.

• Type IV fractures require surgery, either bone grafting and operative fixation with plating or a reconstruction cage for appropriate fixation.

• Type V fractures require operative management, either with reconstruction cages or newer constructs such as the cup–cage model.

Notes