Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fractures of the Acetabulum during and following Total Hip Arthroplasty*†
JOHN J. CALLAGHAN, M.D.‡, IOWA CITY, IOWA

The occurrence of fractures around the femoral component of a total hip prosthesis has been well described, and the treatment options have been studied extensively. However, few reports concerning the occurrence and treatment of periprosthetic fractures of the acetabulum during and following total hip arthroplasty are available10,12,14,18. In this paper, I will review the literature concerning periprosthetic fractures of the acetabulum and outline measures to prevent and treat the problem.

Historical Review

In 1972, Miller described ischiopubic fractures following the insertion of a Ring component without cement in five hips and following the insertion of a McKee component with cement in four. The fractures failed to unite with non-operative treatment, and resection arthroplasty was performed in all of the hips. McElfresh and Coventry documented only one periprosthetic acetabular fracture among 5400 total hip arthroplasties performed with cement at the Mayo Clinic. Silvello et al. reported the successful treatment of a periprosthetic acetabular fracture (associated with loosening of the component) with revision of the component and bone-grafting. More recently, in a study of periprosthetic acetabular fractures following total hip arthroplasty, Peterson and Lewallen reported that long-term survival of the components was poor (eight of ten were revised) unless additional operative intervention was performed. The occurrence and recognition of periprosthetic fractures of the acetabulum, as well as those of the femur, may be on the rise, especially during the intraoperative and early postoperative periods, because of the need for so-called press-fit stability of total hip prostheses inserted without cement1,2,19.

In Vitro Studies

As fixation of the acetabular component without cement has become the standard construct in total hip arthroplasties, problems associated with this approach are now being recognized. In vitro studies have demonstrated minimum bone-prosthesis micromotion when screws have been used to augment …


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