Survivorship of hip after acetabulum fracture fixation – Analysing risk factors associated with early THR

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-02-01 DOI:10.1016/j.jcot.2024.102873

Sandeep Kumar , Priya Yadav , Akash Mishra , Shataayu Gugale , Rohit Goyal , Vivek Bhambhu

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引用次数: 0

Abstract

Introduction

Acetabular fracture fixation principles stated by Letournel and Judet have contributed significantly towards advancement in treatment methodologies. Current day techniques helps to achieve anatomical reduction, still post-traumatic arthritis ensues in some patients. A meta-analysis by Giannoudis et al. revealed osteoarthritis incidence of 13 % in patients with satisfactory reductions (<2 mm) and 44 % with unsatisfactory reductions (>2 mm). Predicting poor outcomes before treatment could improvise patient counselling and treatment selection. This study aims to assess the functional outcomes and analyze risk factors for early total hip replacement (THR) in acetabulum fractures.

Materials and methods

From 2017 to 2024, 560 patients with acetabulum fractures were managed surgically. Out of them 316 had more than 2 years follow up, and were included in this study. Fracture patterns involved 5 elementary and 5 associated types, treated through various surgical approaches and followed up for an average of 3 years. Data collection included demographics, lab investigations, radiographs, and CT scans. Statistical analysis using SPSS version 29.0.2.0 employed Chi-square tests, Fisher's exact tests and Cox proportional hazards regression to identify significant predictors of THR, with P-values <0.05 considered significant.

Results

The study involved 316 patients, with a mean age of 43 years, followed up for 2–7 years. 81 % were males. Most fractures were T-type (17.1 %) and treated using the Modified Stoppa Approach (43.7 %). Anatomic reduction was achieved in 77.2 % patients. Overall, 75.3 % patients had excellent to good outcomes. 32 (10.12 %) of the patients were converted to THR, while 46 (14.5 %) had fair outcomes, and were considered as cases of impending THR. Significant predictors for THR included age, surgical delay, fracture pattern and reduction quality. Age 60 and above, and poor reduction quality were associated with higher THR rates (Hazard ratio = 1.00).

Conclusion

Survivorship of the hip joint post-acetabulum fracture is influenced by age, fracture pattern, surgical delay, and post operative reduction quality. Addressing modifiable factors such as anatomical reductions of the fracture and surgical intervention within one week of injury are crucial for improving long-term outcomes, further reducing the need for THR after acetabular fracture fixation.

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髋臼骨折固定后髋部的存活-分析早期THR的相关危险因素。

Letournel和Judet提出的髋臼骨折固定原则对治疗方法的进步做出了重大贡献。目前的技术有助于实现解剖复位，但一些患者仍会出现创伤后关节炎。Giannoudis等人的一项荟萃分析显示，骨关节炎的发生率为13%，患者复位满意（2mm）。在治疗前预测不良结果可以为患者提供临时咨询和治疗选择。本研究旨在评估髋臼骨折患者早期全髋关节置换术（THR）的功能结局并分析危险因素。材料与方法：2017年至2024年，对560例髋臼骨折患者进行手术治疗。其中316人随访超过2年，并纳入本研究。骨折类型包括5种基本类型和5种相关类型，通过各种手术方式治疗，平均随访3年。数据收集包括人口统计、实验室调查、x光片和CT扫描。统计学分析采用SPSS 29.0.2.0版本，采用卡方检验、Fisher精确检验和Cox比例风险回归，确定THR的显著预测因素，p值为p值。结果：研究纳入316例患者，平均年龄43岁，随访2-7年。81%是男性。大多数骨折为t型（17.1%），采用改良Stoppa入路治疗（43.7%）。77.2%的患者实现解剖复位。总体而言，75.3%的患者预后良好。32例（10.12%）患者转化为THR， 46例（14.5%）患者预后良好，被认为是即将发生THR的病例。THR的重要预测因素包括年龄、手术延迟、骨折类型和复位质量。年龄在60岁及以上，复位质量差与较高的THR率相关（风险比= 1.00）。结论：髋臼后骨折患者的生存率受年龄、骨折类型、手术时间和术后复位质量的影响。解决可改变的因素，如骨折的解剖复位和损伤后一周内的手术干预，对于改善长期预后至关重要，进一步减少髋臼骨折固定后THR的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.