[Periacetabular Fractures in Patients with Hip Arthroplasties]

Keel, Marius; Bastian, Johannes (2015). [Periacetabular Fractures in Patients with Hip Arthroplasties]. OP-Journal, 31(1), pp. 15-21. Georg Thieme Verlag 10.1055/s-0035-1545871

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The incidence of periacetabular fractures in patients with hip arthroplasties is increasing due to the ageing population and the high activity of the elderly. The periprosthetic acetabular fractures are classified according to the classification of Letournel. A periprosthetic acetabular fracture with an involvement of both columns is also called a pelvic discontinuity. Lateral compression injuries can also occur as periacetabular pubic fractures and/or transiliac fractures. Patient-related (age, morbidity, osteoporosis, activity level of the patient), fracture-related (type of fracture, grade of dislocation, impaction of the dome or the posterior wall) as well as prosthesis-related factors (type of prosthesis [hemi-arthroplasty or total arthroplasty], stability of the cup, wear of the prosthesis, grade and localisation of the acetabular lysis, stability or lysis of the prosthesis stem) are considered for the decision of the definitive treatment (conservative, isolated osteosynthesis, revision total hip arthroplasty with or without additional osteosynthesis of the anterior and/or posterior columns) and the choice of the surgical approach. For acute pelvic discontinuities an osteosynthesis of the posterior column and a highly osteointegrative cup (tantalum [trabecular metal: TM]) with or without augmentation and/or allograft and in some complex cases in a cup-cage technique (TM-cup with a reconstructive cage [Burch-Schneider cage]) are recommended according to the therapeutic concept for chronic pelvic discontinuties. In cases with severe acetabular lysis and displacements of the anterior column and quadrilateral plate an additional internal fixation of them through an intrapelvic approach (modified Stoppa approach or Pararectus approach [Keel]) is becoming more popular.

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