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The survival of Cementless Acetabular Cup for Post-Traumatic Osteoarthritis Caused by Acetabular Fracture Compared with Primary Osteoarthritis and Avascular Necrosis of the Hip MS Park M.D., WC Chung, M.D, HM Cho M.D, and KB Kim M.D. Department of Orthopedic Surgery, Medical School, Chonbuk National University Hospital, Jeonju, Korea
Introduction • Total hip arthroplasty (THA) is a common form of surgical treatment when significant joint changes and pain presents such as primary degenerative osteoarthritis, avascular necrosis of femoral head and posttraumatic arthritis
Introduction • In past, the implant survival rate and clinical outcomes was different according to etiologic disease entities in cemented THA • The clinical outcomes of cemented THA in patients with AVN were inferior to those of patients with primary osteoarthritis • Saito S et al,Clin Orthop Relat Res1989;244:198 • Murzic WJ et al, Clin Orthop Relat Res1994;299:212
Introduction • Recent advances in cementless THA have led to improved radiographic and functional parameters • The clinical and radiographic findings after noncemented arthroplasty in patients with osteonecrosis of the femoral head and in patients with degenerative arthritis of the hip were similar in the two groups • Xenakis TA et al, Clin Orthop Relat Res 1997;341:62
Introduction • The clinical outcomes of THA in patients with posttraumatic arthritis after acetabular fracture usually were inferior to those of patients undergoing the procedure for nontraumatic conditions becausethe higher acetabular cup failure rate • Romness DW et al, J Bone Joint Surg Br 1990;72-B:761 • Stauffer RN et al, J Bone Joint Surg Am 1982;64-A:983 • Recent several clinical studies have demonstrated similar clinical and radiologic outcomes between traumatic OA and primary OA • Bellabarba C, JBJS Am 2001 • Pritchett JW, Orthop Rev. 1991
Purpose • To compare the clinical and radiologic results undergoing total hip arthroplasty for posttraumatic arthritis after acetabular fracture with those of the same procedure in patients with avascular necrosis of femoral head and degenerative osteoarthritis
Materials • From March 1993 to May 2000, 512 patients • Primary total hip arthroplasty by single surgeon (MS Park. M.D) • Duofit; SAMO, Bologna, Italy, Mallory-Head; Biomet, Warsaw, USA • Exclusion criteria ( excluded 403 patients) • Over 70 years • Bilateral hip replacement • Rheumatoid arthritis • Crowe type IV
Materials Patients demography * Group A : Primary osteoarthritis † Group B : Avascular necrosis of the femoral head ¥ Group C : Post-Traumatic osteoarthritis
Materials Group C – 33 patients • Demographic data
Methods Osteolysis • Extent of the osteolysis : ≥2mm • Zone of the osteolysis DeLee and Charnley
Methods Acetabularmigration ≥2mm Horizontal migration Vertical migration By Massin P et al
Methods Polyethylene liner wear By Livermore et al
Clinical assessment - Harris hip score
Methods Static analysis • Chi–square test • ANOVA test • Survivorship analysis by Kaplan-Meier method • The end Point • Revision for any reason • Radiologic sign of loosening of acetabular component • Infection • dislocation
Radiologic results Acetabular osteolysis - ≥2mm *: Cases † : Cases (percentage)
Radiologic results Acetabular migration *: Mean scores ± SD P = 0.12
Radiologic results Liner Wear *: Mean scores ± SD P = 0.058
Clinical results Harris hip score * Group A :Post-Traumatic osteoarthritis † Group B : Primary osteoarthritis ¥ Group C : Avascular necrosis of the femoral head P = 0.43 Analysis by ANOVA test
Clinical results Operation *: Mean scores ± SD OP times P = 0.037 Bleeding amounts P = 0.042
Clinical results Complications
Clinical results Revision *: 1 case : Recurrent dislocation – acetabular cup malposition (10〫anteversion) † : 1 case : Deep infection – 2nd stage reimplantation)
Clinical results Survivorship analysis
58 / M Fx & D/L posterior wall, acetabulumn, Lt. (T-E III) GROUP C
ORIF GROUP C
Last FU – 112 months GROUP C
Last FU – 129 months REVISION
Discussion • Total hip arthroplasty in the setting of an acetabular fracture remains a difficult reconstructive dilemma • This results were arised from the adhesion of previous scar tissue formation, poor operation field, and more excessive dissection during previous internal fixators
Discussion • The longer operation times and more amount of bleeding was needed during reconstructive surgery • Bellabarba C, JBJS Am 2001 • In our study, Traumatic arthritis group was statistically the longer operation times and the more amount of bleeding than the other groups
Discussion • In general , the ages and activity level were affected the clinical and radiological results after the THA according to acetabular higher failure rate • Jimenez ML et al, Orthop Clin North Am 1979 • Mears DC et al, Instr Course Lect 2001 • Berry DJ et al, Orthopedics 1999 • In our study, to effort the minimize the influence of age and activity , the age of the three groups were not different statstically .
Discussion • The postoperative Harris hip score of the three groups was improved markedly and was not different statstically • Radiologic results of post-traumatic group were not significantly different compare with non-traumatic other groups.
Discussion • Component survival rate was also comparable between the groups treated for post-traumatic and non-traumaticother groups • In addition, Of the 8 cases undergone revision, 6 cases were loosened by aseptic osteolysis and all these cases were below the 50yrs old
Discussion • The two other revised cases were affected the patients comorbidity(DM), and implant malpositioning (10° anteversion) • We consider that implant survival was affected the combination factors notetiologic disease entities
Conclusion • Cementless THA for posttraumatic arthritis after acetabular fracture shows the almost same clinical and radiological results of compared with the same age group of patients of avascular osteonecrosis of the femoral head and degenerative osteoarthritis.
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