[Surgical treatment of acetabulum fractures in the elderly. Osteosynthesis or endoprosthesis]

Abstract

Background: Anatomical reconstruction of acetabulum fractures and rigid osteosynthesis are required to achieve good postoperative results. In the 7(th) decade of life changes of bone quality impair stability of fixation devices in bone.

Patients and methods: This retrospective study evaluates and compares results of osteosynthesis and implantation of total hip arthroplasty in patients with acetabulum fractures. A total of 24 patients older than 65 years who sustained acetabular fractures type A, B and C according to AO classification were examined using several clinical measurements. Different scores for physical function, pain, general health and subjective assessment including psychosocial aspects were used. The outcome criteria were evaluated 1.5-10 years after surgery.

Results: Good reconstruction of the acetabulum was only achieved in 40 % of patients which corresponded with radiological long-term results. Pain relief and mobility were slightly better in patients who received primary alloarthroplasty of the hip joint, and periarticular ossification was observed more frequently following osteosynthesis. Surgical revisions were necessary more often after osteosynthesis of the acetabulum. The small number of cases showed no significant differences. The functional outcome did not show significant differences between primary alloarthroplasty and reconstruction of the acetabulum.

Conclusion: Primary implantation with alloarthroplasty of the hip joint in case of a complex fracture of the acetabulum can be recommended for elderly patients if an anatomic or good reconstruction of the hip joint cannot be achieved.