[Hip prostheses as a treatment for acetabular fractures in the elderly].

Abstract

Introduction: low-energy acetabular fractures in older adults have significantly increased, with an incidence up to 2.4 times higher over the last three decades. While osteosynthesis is the standard treatment in young patients, its suitability for older adults is debated due to higher risks of complications and reinterventions. These risks are exacerbated by osteoporosis, comminution, and articular surface damage, such as femoral head impaction and preexisting conditions like coxarthrosis. The literature suggests that total hip arthroplasty (THA) may be more appropriate in cases of severe displacement, articular comminution, acetabular impaction in the load zone, and other complex scenarios.

Material and methods: this retrospective study analyzed patients over 65 years with acetabular fractures treated with THA between 2008 and 2018, with a minimum follow-up of one year. Parameters evaluated included fracture type, mechanism of injury, associated injuries, use of traction, time to surgery, type of implant, and complications. Clinical evaluations utilized the Merle d'Aubigné-Postel (MAP) scale, and statistical analysis was conducted using SPSS 18.0.

Results: seven patients were included, with a mean age of 76.4 years. The most common fracture was anterior column with associated posterior hemi-transverse. The most used implant was the uncemented tantalum revision acetabulum. The mean follow-up period was 7.8 years, with an average MAP score of 16.6 at one year. No intraoperative complications occurred, and radiographic consolidation was observed in all cases at three months.

Conclusions: THA showed good clinical outcomes in older adults with acetabular fractures, without increasing the risk of complications, and demonstrated high long-term survival.