gms | German Medical Science

Objectives: To explore the causes and treatment strategies of intra-operative acetabular fractures during total hip arthroplasty and to conceive a new intra-operative acetabular fracture classification.

Methods: We collected 1065 hips which had received the surgery of THA in our two hospitals from 2007 to 2016, separately, they were 660 femoral neck fractures,334 avascular necrosis and 71 hip dysplasia patients ,and among in them, thirteen patients had experienced intra-operative acetabular fractures during THA. The thirteen patients included 5 men and 8 women who were aged from 52 to 81 years old. Among in the thirteen cases, one patient was hip dysplasia, eight of them were femoral neck fractures patients and four of them were avascular necrosis disease. We separately deal with them according to our experience and principles in guidelines. The thirteen patients were followed up from 0.5 to 5 years with an average of 42 months and the function of the hips were evaluated by the Harris rating scale of the hip function. We analysizsed and summarized the previous literatures, combined with our clinical experience, communicated with our fellows and the results of the follow-up data of our patients. At last, basing on the situation of our cases, we tried to conceive a new intra-operative acetabular fracture classification.

Results: These thirteen cases' postoperative X-rays indicated that the patients' prosthesis were in good Location and the incisions were all healed in the first intention without any early complications. The postoperative X-ray also indicated that the fractures were all up to clinical healing at the eight week and without founding any signs of acetabular peri-prosthetic radiolucenting and loosening during our follow-up. Both of the final Harris score were significantly different from their preoperative Harris score which has a statistical significance. At last, we conceived a new intra-operative acetabular fracture classification. That is type I:The fractures do not affect the stability of the acetabular, which including such anterior, posterior, internal and external walls fractures of the acetabular; type II: The fractures affect the stability of acetabular, such as the anterior column and posterior column fractures, which have long fracture lines; type III: The fractures lose its acetabular discontinuity, this type are divided into two subtypes, of which type IIIA: the stability of acetabular is acceptable, type IIIB: the acetabular lose its stability.

Conclusion: As good results in that intra-operative acetabular fractures by applying our experience in dealing with this intra-operative acetabular fractures during THA, we conceived a classification of the acetabular fracture during THA and its treatment strategy. However, the classification and treatment strategy we proposed was just a personal experience and it needs a further large sample to validately and support.