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Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

ABSTRACT: BACKGROUND/OBJECTIVE:Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group. DESIGN:A retrospective population-based cohort study. SETTING:Data were gathered from the Taiwan National Health Insurance Research Database. PARTICIPANTS:We enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period. RESULTS:The THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001). CONCLUSION:The incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

SUBMITTER: Chung TC

PROVIDER: S-EPMC7122785 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

Chung Tzu-Chun TC Chen Tzu-Shan TS Hsu Yao-Chun YC Kao Feng-Chen FC Tu Yuan-Kun YK Liu Pao-Hsin PH

PloS one 20200403 4

<h4>Background/objective</h4>Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group.<h4>Design</h4>A retrospective population-based cohort study.<h4>Setting</h ...[more]

PMID: 32243484

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Project description:BackgroundTotal hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear.Questions/purposesThe primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip.Patients and methodsWe enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip.ResultsA total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications.ConclusionSalvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III.

Dataset Information

Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

Publications

Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

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