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All issues Volume 3 (2017) SICOT-J, 3 (2017) 37 Full HTML

Table 1.

Primary and Secondary total hip replacement (THR) following acetabular fractures. In order to define the individualized treatment plan for elderly patients with acetabular fractures, advantage and disadvantage of primary and secondary THR have to be considered.

Total hip replacement (THR) following acetabular fractures
Primary THR following acetabular fractures Advantages:

  • Good functional outcomes reported.

  • Immediate weight bearing possible.
Disadvantages:

  • Risk of aseptic loosening. Stable fixation challenging due to fracture situation, comminution, and poor bone quality.

  • Risk of dislocation (esp. in patients with cognitive or neurological impairment).

  • Risk of heterotopic ossifications.

  • Thorough preoperative planning necessary, special implants might be needed (e.g. Müller acetabular reinforcement ring).
Secondary THR following acetabular fractures Advantages:

  • Defined bone stock, (mostly) consolidated fracture.

  • Bone grafting, cemented cups, and reconstruction of anatomy associated with improved outcomes.
Disadvantages:

  • Failure rate higher due to abnormal anatomy, impeding hardware, and/or bone stock loss.

  • Thorough preoperative planning necessary, special implants might be needed (e.g. Müller acetabular reinforcement ring).

  • Surgery challenging due to scar tissue, heterotopic ossifications, soft tissue or bone defects, avascularity, and the possibility of occult infection.

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