Joseph AlsousouCambridge University Hospitals , United Kingdom
Title: Acute total hip arthroplasty in acetabular fractures: Fix and replace
Acetabular fractures surgical management is complex requiring prolonged operations and long hospital stay. Open reduction internal fixation (ORIF) is challenging with high risk of failure and posttraumatic arthritis. The acute fix and replace (ATHR) is becoming increasingly popular for the early weightbearing potential. This study aims to systematically review the literature to determine the populations, techniques, outcomes and complications. Random-effect meta-analysis of complication rates will be reported for studies with adequate data.
Independent researchers searched the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2020. Covidence tool was used to screen, extract data and perform Ottawa-Newcastle bias scoring (ONS). 36 studies with 735 ATHR out of 1614 acetabular fractures were reviewed. Population and complications, including heterotopic ossification (HO), dislocation, infection, revision, neurological deficits, and venous thromboembolic event (VTE) were analyzed
A wide variety of approaches, fixation, THA implants and outcome measures were used. Follow up was 36.4 months (0-188) and age 69.3 (15-101). Random-effect model showed an overall complication rate of 27% (95%CI 20.3-70.8%). HO was the most common (20.1%). The complications rate excluding HO is 12.85% including: dislocation 3.5%, embolism 2.7%, infection 3.6%, Nerve palsy 0.9%, revision 2.5% and mortality 5.5%. Blood loss was 813.1ml (27-1233.3ml) and operative time 181.4 minutes ( 93-340). There was no implant or patient survival, or health economic analysis. ONS was poor in 34 and medium in 2 studies.
Acute fix and replace (simultaneous or staged) is a reasonable option for treatment of displaced acetabular fracture. However, the current literature consists of case series or cohort studies with variable methods, design, technique and follow-up. There is no adequality-powered robust clinical trials of ATHR versus ORIF alone. Randomized controlled clinical trials to evaluate acute THA acetabular fractures is warranted.
Joseph Alsousou has completed his PHD at the from the University of Oxford, UK. He is a Trauma and Orthopaedic Consultant Surgeon with interest in Pelvis and acetabulum trauma surgery and Hip arthroplasty. He held NIHR grants for research projects in orthopaedic surgery and has gained multiple national and international awards.