Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications
Notice bibliographique
Résumé
BACKGROUND: Despite modern fracture management techniques allowing for near anatomic reduction of acetabular fractures, there continues to be a risk of posttraumatic arthritis and need for total hip arthroplasty (THA). Few well-controlled studies have compared THA after acetabular fractures with THAs performed for other indications in terms of survivorship or complications, and none, to our knowledge, present 10-year survivorship data in this setting. QUESTIONS/PURPOSES: (1) How does the 10-year survival of THA compare between those patients who underwent THA after an acetabular fracture and those who underwent THA for primary arthritis or avascular necrosis (AVN)? (2) Is there an increased risk of serious complications like infection, dislocation, and aseptic loosening as well as heterotopic ossification associated with a THA performed after a previous acetabular fracture? METHODS: This retrospective case-control study compared findings of patients who underwent THA after acetabular fracture versus a matched cohort of patients who had received a primary THA for primary osteoarthritis or AVN. Between 1987 and 2011, we performed 95 THAs after acetabular fracture; of those, 74 (78%) met inclusion criteria and had documented followup beyond 2 years in our institutional registry. We selected 74 matched patients based on an algorithm that matched patients based on preoperative diagnosis, date of operation, age, gender, and type of prosthesis. During this time, we performed approximately 8000 THAs that were potentially available for matching based on complete followup beyond 2 years. We compared cases and control subjects using the Kaplan-Meier survivorship estimator as well as a comparison of the proportions in each group that developed major complications (including infection, dislocation, loosening, and heterotopic ossification) based a retrospective chart review. RESULTS: The 10-year survivorship after THA was lower in patients with a previous acetabular fracture than in the matched cohort (70%, 95% confidence interval [CI], 64%-78%, versus 90%, 95% CI, 86-95%; p < 0.001). There was no difference in the 10-year survival rate for those patients whose acetabular fracture was initially treated conservatively and those treated by open reduction and internal fixation. Patients with previous acetabular fracture had a higher likelihood of developing infection (7% [five of 74] versus 0% [zero of 74]; odds ratio [OR], 11.79; p = 0.028), dislocation (11% [eight of 74] versus 3% [two of 74]; OR, 4.36; p = 0.048), or heterotopic ossification (43% [32 of 74] versus 16% [12 of 74]; OR, 3.93; p < 0.001). CONCLUSIONS: In this case-control study, patients with a prior acetabular fracture had markedly inferior 10-year survivorship and more frequent serious complications when compared with patients undergoing THA for primary osteoarthritis or AVN. Given these findings, management of these complex cases should be in highly specialized units where the expertise of arthroplasty and trauma reconstruction is available. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».