The survival of Cementless Acetabular Cup for PostTraumatic

The survival of Cementless Acetabular Cup for Post-Traumatic Osteoarthritis Caused by Acetabular Fracture Compared with Primary Osteoarthritis and Avascular Necrosis of the Hip MS Park M. D. , WC Chung, M. D, HM Cho M. D, and KB Kim M. D. Department of Orthopedic Surgery, Medical School, Chonbuk National University Hospital, Jeonju, Korea

Introduction Total hip arthroplasty (THA) is a common form of surgical treatment when significant joint changes and pain presents such as primary degenerative osteoarthritis, avascular necrosis of femoral head and posttraumatic arthritis

Introduction In past, the implant survival rate and clinical outcomes was different according to etiologic disease entities in cemented THA The clinical outcomes of cemented THA in patients with AVN were inferior to those of patients with primary osteoarthritis Saito S et al, Clin Orthop Relat Res 1989; 244: 198 Murzic WJ et al, Clin Orthop Relat Res 1994; 299: 212

Introduction Recent advances in cementless THA have led to improved radiographic and functional parameters The clinical and radiographic findings after noncemented arthroplasty in patients with osteonecrosis of the femoral head and in patients with degenerative arthritis of the hip were similar in the two groups Xenakis TA et al, Clin Orthop Relat Res 1997; 341: 62

Introduction The clinical outcomes of THA in patients with posttraumatic arthritis after acetabular fracture usually were inferior to those of patients undergoing the procedure for nontraumatic conditions because the higher acetabular cup failure rate Romness DW et al, J Bone Joint Surg Br 1990; 72 -B: 761 Stauffer RN et al, J Bone Joint Surg Am 1982; 64 -A: 983 Recent several clinical studies have demonstrated similar clinical and radiologic outcomes between traumatic OA and primary OA Bellabarba C, JBJS Am 2001 Pritchett JW, Orthop Rev. 1991

Purpose To compare the clinical and radiologic results undergoing total hip arthroplasty for posttraumatic arthritis after acetabular fracture with those of the same procedure in patients with avascular necrosis of femoral head and degenerative osteoarthritis

Materials and methods

Materials From March 1993 to May 2000, 512 patients Primary total hip arthroplasty by single surgeon (MS Park. M. D) Duofit; SAMO, Bologna, Italy, Mallory-Head; Biomet, Warsaw, USA Exclusion criteria ( excluded 403 patients) Over 70 years Bilateral hip replacement Rheumatoid arthritis Crowe type IV

Materials Patients demography Group A* Group B† Group C¥ 34(6: 24) 42(24: 6) 33(15: 6) Average (yrs) 62. 7 58. 7 56. 4 Average follow up(yrs) 10. 2 9. 8 10. 4 Bearing type MOP MOP Femoral head size 28 mm Duo(SAMO, Bologna, Italy) 25 28 20 Mallory-Head(Biomet, Warsaw, USA 9 14 13 Gender (M/F) Implant * Group A : Primary osteoarthritis † Group B : Avascular necrosis of the femoral head ¥ Group C : Post-Traumatic osteoarthritis

Materials Group C – 33 patients Demographic data Sex 22 males /11 females Side 19 right / 14 left Management 28 ORIF / 5 non-op Age (trauma) 53 yrs ( 33 -68 ) Age (THA) 56 yrs ( 36 -69 ) Time (trauma to THA) Associated injury 36 months ( 1 -127 mo) 13

Methods Osteolysis Extent of the osteolysis : ≥ 2 mm Zone of the osteolysis De. Lee and Charnley

Methods Acetabular migration ≥ 2 mm Horizontal migration Vertical migration By Massin P et al

Methods Polyethylene liner wear By Livermore et al

Clinical assessment - Harris hip score

Methods Static analysis Chi –square test ANOVA test Survivorship analysis by Kaplan-Meier method The end Point ○ Revision for any reason Radiologic sign of loosening of acetabular component Infection dislocation

Results

Radiologic results Acetabular osteolysis - ≥ 2 mm Group A Group B Group C Zone I 1* 2 3 Zone II 2 5 2 Zone III 6 8 6 9 (29. 4%) † 15(35. 7%) 11(33. 3%) *: Cases † : Cases (percentage) P-value 0. 067

Radiologic results Acetabular migration Cases (%) Migration (mm) Group A 1(3) 1. 0± 1. 74* Group B 5(12) 1. 7± 0. 56 Group C 3(10) 1. 9± 0. 78 *: Mean scores ± SD P = 0. 12

Radiologic results Liner Wear Linear Wear(mm) Rate of Linear Wear (mm/yr. ) Group A 0. 58 (0 -1. 7) ± 0. 7* 0. 06 (0 -0. 16) ± 0. 06 Group B 1. 35 (0 -4. 3) ± 1. 0 0. 13 (0 -0. 41) ± 01 Group C 1. 51 (0 -6. 1) ± 1. 4 0. 14 (0 -0. 59) ± 0. 11 *: Mean scores ± SD P = 0. 058

Clinical results Harris hip score P = 0. 43 Analysis by ANOVA test * Group A : Post-Traumatic osteoarthritis † Group B : Primary osteoarthritis ¥ Group C : Avascular necrosis of the femoral head

Clinical results Operation OP times(min) Bleeding amount (ml) Group A 88± 2. 34* 363± 5. 41 Group B 82± 3. 45 350± 4. 41 Group C 105± 4. 15 698± 7. 15 *: Mean scores ± SD OP times P = 0. 037 Bleeding amounts P = 0. 042

Clinical results Complications Cases Peroneal nerve palsy 2 Dislocation 2 Deep vein thrombosis 4 Superficial infection 1 Deep infection 1

Clinical results Revision Group A Group B Group C Whole cup exchange 1 3* 0 Cemented isolated liner exchange 0 2 1 Cup and stem revision 0 0 1† 1 5 2 *: 1 case : Recurrent dislocation – acetabular cup malposition (10� anteversion) † : 1 case : Deep infection – 2 nd stage reimplantation)

Clinical results Survivorship analysis

Cases

58 / M Fx & D/L posterior wall, acetabulumn, Lt. (T-E III) GROUP C

ORIF GROUP C

Last FU – 112 months GROUP C

46/M – POD 34 months Avascular necrosis of femral head REVISION

Last FU – 129 months REVISION

Discussion

Discussion Total hip arthroplasty in the setting of an acetabular fracture remains a difficult reconstructive dilemma This results were arised from the adhesion of previous scar tissue formation, poor operation field, and more excessive dissection during previous internal fixators

Discussion The longer operation times and more amount of bleeding was needed during reconstructive surgery Bellabarba C, JBJS Am 2001 In our study, Traumatic arthritis group was statistically the longer operation times and the more amount of bleeding than the other groups

Discussion In general , the ages and activity level were affected the clinical and radiological results after the THA according to acetabular higher failure rate Jimenez ML et al, Orthop Clin North Am 1979 Mears DC et al, Instr Course Lect 2001 Berry DJ et al, Orthopedics 1999 In our study, to effort the minimize the influence of age and activity , the age of the three groups were not different statstically.

Discussion The postoperative Harris hip score of the three groups was improved markedly and was not different statstically Radiologic results of post-traumatic group were not significantly different compare with non-traumatic other groups.

Discussion Component survival rate was also comparable between the groups treated for post-traumatic and non-traumatic other groups In addition, Of the 8 cases undergone revision, 6 cases were loosened by aseptic osteolysis and all these cases were below the 50 yrs old

Discussion The two other revised cases were affected the patients comorbidity(DM), and implant malpositioning (10° anteversion) We consider that implant survival was affected the combination factors not etiologic disease entities

Conclusion Cementless THA for posttraumatic arthritis after acetabular fracture shows the almost same clinical and radiological results of compared with the same age group of patients of avascular osteonecrosis of the femoral head and degenerative osteoarthritis.

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