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Acetabular Fracture

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David L Helfet – 1st expert on this subject based on the ideXlab platform

  • long term patient reported outcomes following Acetabular Fracture fixation
    Injury-international Journal of The Care of The Injured, 2018
    Co-Authors: Jelle P Van Der List, Diederik O Verbeek, Camden M Tissue, David L Helfet

    Abstract:

    Abstract Introduction Patient reported outcome scores may be the preferred method to assess clinical results following Acetabular Fracture fixation. However, in current Acetabular Fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following Acetabular Fracture surgery and to evaluate the association between reduction quality and these outcome measures. Methods Patients who received operative fixation for Acetabular Fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT: 3 mm displacement). Outcome scores between native hip versus total hip arthroplasty (THA) and adequate versus inadequate reduction groups were compared and association between reduction quality and hip survivorship was determined. Subgroup analysis was performed in older patients (≥50 years). Results Patients with native hips reported overall superior relevant outcome scores (SMFA function index (p = 0.047), mobility (p = 0.048) and SF-12 physical component (p = 0.008)) compared to THA patients. Hip survivorship was associated with adequate reductions (p = 0.019). In the native hip group, an adequate reduction was also associated with lower (better) clinical scores (exceeding the minimal clinical important difference) (MCID) specifically for SMFA function index (p = 0.117) and mobility (p = 0.022). In elderly patients, the native hip versus THA group had similar outcomes, and adequate reductions were associated with hip survivorship as well as superior clinical scores (at least exceeding the MCID) in those who retained their native hip. Conclusion At long-term follow-up, Acetabular Fracture surgery is associated with excellent patient reported outcomes. Patients who retain their native hip have overall superior relevant (SMFA and SF-12) function scores compared to those who convert to THA. Adequate reductions (on CT) were associated with both hip survivorship and superior outcome scores in patients who retain their hip.

  • predictors for long term hip survivorship following Acetabular Fracture surgery importance of gap compared with step displacement
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Camden M Tissue, David L Helfet

    Abstract:

    BACKGROUND: Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following Acetabular Fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. METHODS: Patients who had Acetabular Fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old). RESULTS: The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. CONCLUSIONS: Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • postoperative ct is superior for Acetabular Fracture reduction assessment and reliably predicts hip survivorship
    Journal of Bone and Joint Surgery American Volume, 2017
    Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Jordan C Villa, David S Wellman, David L Helfet

    Abstract:

    BACKGROUND: Postoperative pelvic radiographs are routinely used to assess Acetabular Fracture reduction. We compared radiographs and computed tomography (CT) with regard to their ability to detect residual Fracture displacement. We also determined the association between the quality of reduction as assessed on CT and hip survivorship and identified risk factors for conversion to total hip arthroplasty (THA). METHODS: Patients were included in the study who had undergone Acetabular Fracture fixation between 1992 and 2012, who were followed for ≥2 years (or until early THA), and for whom radiographs and a pelvic CT scan were available. Residual displacement was measured on postoperative radiographs and CT and graded according to Matta’s criteria (0 to 1 mm indicating anatomic reduction; 2 to 3 mm, imperfect reduction; and >3 mm, poor reduction) by observers who were blinded to patient outcome. Kaplan-Meier survivorship curves were plotted and log-rank tests were used to assess statistical differences in survivorship curves between adequate (anatomic or imperfect) and inadequate reductions on CT. Cox proportional hazard regression analysis was used to identify risk factors for conversion to THA. Two hundred and eleven patients were included. At mean of 9.0 years (standard deviation [SD], 5.6; median, 7.9; range, 0.5 to 23.3 years) postoperatively, 161 patients (76%) had retained their native hip. RESULTS: Compared with radiographs, CT showed worse reduction in 124 hips (59%), the same reduction in 79 (37%), and better reduction in 8 (4%). Of the 99 patients graded as having adequate reduction on CT, 10% underwent conversion to THA in comparison with 36% of those with inadequate reduction, and there was a significant difference between the survivorship curves (p < 0.001). Mean hip survivorship was shorter in patients ≥50 years of age (p < 0.001) and in those with an inadequate reduction on CT (p < 0.001). Independent risk factors for conversion to THA were age (hazard ratio [HR] = 4.46, 95% confidence interval [CI] = 2.07 to 9.62; p < 0.001), inadequate reduction (HR = 3.57, 95% CI = 1.71 to 7.45; p = 0.001), and posterior wall involvement (HR = 1.81, 95% CI = 1.00 to 3.26; p = 0.049). Sex, Fracture type (elementary versus associated), and year of surgery did not influence hip survivorship. CONCLUSIONS: CT is superior to radiographs for detecting residual displacement after Acetabular Fracture fixation. Hip survivorship is greater in patients with adequate (anatomic or imperfect) reduction on CT. Along with older age and posterior wall involvement, an inadequate reduction on CT is a risk factor for conversion to THA. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Daniel J Berry – 2nd expert on this subject based on the ideXlab platform

  • total hip arthroplasty after operatively treated Acetabular Fracture a concise follow up at a mean of twenty years of a previous report
    Journal of Bone and Joint Surgery American Volume, 2015
    Co-Authors: Philipp Von Roth, Matthew P Abdel, Scott W Harmsen, Daniel J Berry

    Abstract:

    Abstract:Acetabular Fractures increase the risk of posttraumatic arthritis and thus the risk of total hip arthroplasty (THA). We previously presented the ten-year results of THA performed for posttraumatic arthritis after an Acetabular Fracture; we now present the twenty-year outcomes. The original

  • uncemented Acetabular components for arthritis after Acetabular Fracture
    Clinical Orthopaedics and Related Research, 2002
    Co-Authors: Daniel J Berry, Michael P Halasy

    Abstract:

    The purpose of the current study was to evaluate the results of uncemented Acetabular components used to treat posttraumatic arthritis after Acetabular Fracture at a minimum of 10 years. Thirty-four hips in 33 patients (mean age, 49.7 years, range, 19-78 years) were treated from 1984 to 1990 at one institution with a total hip arthroplasty using an uncemented titanium porous-coated socket. Four patients died before 10 years (all with implants intact). Nine patients had the acetabulum revised: four had the shell and liner revised (one for loosening, one for loosening and dislocation, and two for osteolysis) and five had the liner alone revised (three for polyethylene wear and two for dislocation). All patients with unrevised hip replacements who were alive and patients who were not lost to followup had no or minimal pain at final followup (range, 10-16 years); no components were radiographically loose. Uncemented sockets had a low rate of loosening in this challenging patient population, but polyethylene wear and osteolysis were problematic.

  • Acetabular Fracture associated with cementless Acetabular component insertion a report of 13 cases
    Journal of Arthroplasty, 1999
    Co-Authors: Peter F Sharkey, Arlen D Hanssen, William J Hozack, John J Callaghan, Daniel J Berry, David G Lewallen

    Abstract:

    Abstract Acetabular Fracture during insertion of a cementless Acetabular component occurred in 13 patients. The preoperative diagnosis was osteoarthritis in 6 patients, rheumatoid arthritis in 2 patients, avascular necrosis in 3 patients, hip Fracture nonunion in 1 patient, and developmental dysplasia of the hip in 1 patient. Several different components were used; however, the acetabulum was underreamed by 1 to 3 mm in all cases. The Acetabular Fracture was identified in 9 of 13 cases intraoperatively. The Fracture was identified on postoperative radiographs for the other 4 cases. Fractures were treated by a variety of means, including the addition of augmentation screws in or around the cup, use of autograft bone at the Fracture site, modified postoperative weight-bearing status, and immobilization. In 2 cases, the socket needed to be revised after it progressively migrated and failed. One patient had cup migration, and another had a radiolucent line about the cup but was not symptomatic enough to require revision. In 3 of these 4 cases, the Fracture was not identified intraoperatively. Underreaming of the acetabulum and use of an oversized Acetabular component has been recommended to improve the initial stability of the Acetabular component during total hip arthroplasty. Impaction of an oversized component requires bone to undergo plastic deformation if the cup is to be fully seated. Theoretically, this technique provides improved component stability with enhanced osseous ingrowth into the cup. The 13 cases reported in this study demonstrate that Acetabular Fracture is a complication that may occur in association with uncemented hip arthroplasty, particularly if oversized components are used. The importance of recognizing Acetabular Fractures intraoperatively and the need to institute appropriate treatment to ensure a stable Acetabular component is emphasized. In patients with osteoporotic bone, line-to-line reaming with use of a cementless Acetabular component or insertion of a cemented socket may be considered to avoid this significant complication.

Diederik O Verbeek – 3rd expert on this subject based on the ideXlab platform

  • What is the value of 3D virtual reality in understanding Acetabular Fractures
    European Journal of Orthopaedic Surgery and Traumatology, 2019
    Co-Authors: L. Brouwers, Albert F. Pull Ter Gunne, Mariska A.c. De Jongh, Thomas J.j. Maal, Rinaldo D. Vreeken, Frank H. W. M. Van Der Heijden, Luke P. H. Leenen, Willem R. Spanjersberg, Sven H. Van Helden, Diederik O Verbeek

    Abstract:

    Background
    Acetabular Fractures are difficult to classify owing to the complex three-dimensional (3D) anatomy of the pelvis. 3D printing helps to understand and reliably classify Acetabular Fracture types. 3D-virtual reality (VR) may have comparable benefits. Our hypothesis is that 3D-VR is equivalent to 3D printing in understanding Acetabular Fracture patterns.

  • long term patient reported outcomes following Acetabular Fracture fixation
    Injury-international Journal of The Care of The Injured, 2018
    Co-Authors: Jelle P Van Der List, Diederik O Verbeek, Camden M Tissue, David L Helfet

    Abstract:

    Abstract Introduction Patient reported outcome scores may be the preferred method to assess clinical results following Acetabular Fracture fixation. However, in current Acetabular Fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following Acetabular Fracture surgery and to evaluate the association between reduction quality and these outcome measures. Methods Patients who received operative fixation for Acetabular Fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT: 3 mm displacement). Outcome scores between native hip versus total hip arthroplasty (THA) and adequate versus inadequate reduction groups were compared and association between reduction quality and hip survivorship was determined. Subgroup analysis was performed in older patients (≥50 years). Results Patients with native hips reported overall superior relevant outcome scores (SMFA function index (p = 0.047), mobility (p = 0.048) and SF-12 physical component (p = 0.008)) compared to THA patients. Hip survivorship was associated with adequate reductions (p = 0.019). In the native hip group, an adequate reduction was also associated with lower (better) clinical scores (exceeding the minimal clinical important difference) (MCID) specifically for SMFA function index (p = 0.117) and mobility (p = 0.022). In elderly patients, the native hip versus THA group had similar outcomes, and adequate reductions were associated with hip survivorship as well as superior clinical scores (at least exceeding the MCID) in those who retained their native hip. Conclusion At long-term follow-up, Acetabular Fracture surgery is associated with excellent patient reported outcomes. Patients who retain their native hip have overall superior relevant (SMFA and SF-12) function scores compared to those who convert to THA. Adequate reductions (on CT) were associated with both hip survivorship and superior outcome scores in patients who retain their hip.

  • predictors for long term hip survivorship following Acetabular Fracture surgery importance of gap compared with step displacement
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Camden M Tissue, David L Helfet

    Abstract:

    BACKGROUND: Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following Acetabular Fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. METHODS: Patients who had Acetabular Fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old). RESULTS: The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. CONCLUSIONS: Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.