Case Report

Split Viewer

Hip Pelvis 2024; 36(2): 155-160

Published online June 1, 2024

https://doi.org/10.5371/hp.2024.36.2.155

© The Korean Hip Society

Periprosthetic Acetabular Fracture after Total Hip Arthroplasty: A Report on Two Cases

Joonkyoo Kang, MD , Chan Young Lee, MD , Taek-Rim Yoon, MD, PhD , Kyung-Soon Park, MD, PhD

Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

Correspondence to : Kyung-Soon Park, MD, PhD https://orcid.org/0000-0002-5036-1803
Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea
E-mail: chiasma@hanmail.net

Received: October 12, 2023; Revised: December 11, 2023; Accepted: December 11, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

We report two cases of postoperative total hip arthroplasty periprostehtic fracture of the acetabulum which treated by open reduction with internal fixation without acetabular cup revision. From these cases, we should consider open reduction with internal fixation as the first treatment option in cases where spot welding of the cup to the host bone is observed.

Keywords Total hip arthroplasty, Periprosthetic fracture, Acetabulum

Periprosthetic fracture of the acetabulum after total hip arthroplasty (THA) is rare. Although the precise incidence is unknown, an incidence of 0.07%-0.8% of patients undergoing THA has been reported1-3). The number of THAs performed has shown a steady increase with increasing life expectancy. By contrast, an increase in vehicle-related high-energy traumas, along with an osteoporotic elderly population have contributed to an increase in the incidence of periprosthetic fracture after THA. Thus, the importance of this rare but challenging fracture has increased.

Periprosthetic fracture of the acetabulum is classified according to implant stability, bone stock status, fracture pattern, and time (intraoperative vs. postoperative). The goal of treatment is to achieve bone union with a stable implant and congruent joint status, which can be challenging for most orthopedic surgeons due to the rarity of the condition and treatment requires a high level of osteosynthesis and hip arthroplasty skills. We report on two cases of periprosthetic acetabular fracture after primary THA that were treated successfully with osteosynthesis without cup revision.

1. Case 1

A 46-year-old female patient underwent simultaneous bilateral primary THA with ceramic-on-ceramic articulation for treatment of osteoarthritis due to the sequelae of developmental dysplasia of the hip. No notable complications were observed during outpatient follow-up until six years post-surgery. The patient presented to our hospital’s emergency room due to a vehicle rollover accident without collision. Radiographs showed a right THA periprosthetic fracture of the acetabular component (Fig. 1). Although the posterior column of an acetabulum fracture with cup medial displacement was identified, computed tomography (CT) showed no osteolysis and spot welding was observed at the inferior and posterior cup margin (Fig. 2).

Fig. 1. (A) An anteroposterior radiograph of the pelvis shows a right total hip arthroplasty periprosthetic fracture of the acetabular component and medial displacement of the acetabular cup. (B) The iliac oblique view shows a disrupted ilioischial line. Arrows: spot welding.
Fig. 2. (A) Computed tomography (CT) axial view shows spot welding at the posterior cup. (B) CT coronal view shows spot welding at the inferior portion of the cup. (C) CT sagittal view shows disruption of the posterior column around the acetabular component. Arrows: spot welding.

Concentric reduction of the acetabular posterior column was achieved by wiring through the greater sciatic notch4). Additional posterior plating was performed for the posterior column (Fig. 3A, B). After two months of non-weight bearing following fixation surgery, the patient was allowed partial weight bearing. At three months after surgery, complete union of the fracture was observed, and the patient was able to walk freely. The patient is currently (seven years and seven months after the fracture operation) under observation and has not experienced any complications. In addition, no radiolucent line was observed around the acetabular component at the last follow up (Fig. 3C, D).

Fig. 3. (A, B) Immediate postoperative radiographs show concentric acetabular posterior column reduction with wiring and additional posterior plating. (C, D) The last follow-up radiographs at seven years and seven months after the fracture operation show successful bony union and no osteolysis.

2. Case 2

A 67-year-old female patient underwent primary THA with ceramic-on-ceramic articulation for treatment of a left displaced femoral neck fracture. Multiple osteoporotic compression fractures were detected at the lumbar vertebra during the preoperative evaluation and measurement of bone mineral density indicated severe osteoporosis, with an L1-L4 T-score of –3.1 despite receiving oral bisphosphonate (Risedronate and Actonel) therapy for several years. The patient returned to previous household ambulatory activity levels a few months after surgery, and successful osteointegration of the THA was confirmed on the final follow-up radiograph (four years after the operation).

The patient presented to a local clinic 10.5 years after surgery for left hip pain after a slip down. A radiograph showed a left THA-related periprosthetic fracture of the acetabular component. Diffuse radiolucency was observed around the posterior column of the acetabular cup and medial cup displacement was also observed (Fig. 4). Conservative management was initially attempted at another hospital, however, the patient complained of sustained pain and presented to our hospital. A follow-up radiograph after one month showed increased medial displacement of the acetabular component (Fig. 5). Callus formation, no bone bridge formation, and a bone defect were observed around the superior and medial portions of the acetabular cup on CT (Fig. 6).

Fig. 4. An initial radiograph taken at another hospital the patient visited after slipping shows a left total hip arthroplasty periprosthetic fracture of the acetabular component with medial displacement.
Fig. 5. (A) A radiograph taken after one month of conservative treatment shows increased medial displacement of the acetabular component. (B) The iliac oblique view shows a disrupted ilioischial line and subluxation of the ceramic head. Arrow: spot welding.
Fig. 6. (A-C) Computed tomography shows callus formation around the fracture site with no bone bridge formation and bone defects around the superior and medial portions of the acetabular cup. Arrowheads: callus formation, arrow: spot welding.

Intraoperatively, although bone ingrowth was partially maintained, bone defects were observed at the superior and medial portions of the acetabulum after reduction of the fracture. Two posterior plates were fixed, and the bone defect site was filled with a femoral head allograft (Fig. 7). The patient was instructed to use a wheelchair and to avoid weight-bearing activity and subcutaneous injections of teriparatide (Forsteo; Lilly) were prescribed for three months. Successful bony union and osteointegration of the acetabular component were observed on a radiograph taken three months after surgery (Fig. 8A, B). A congruent joint state without bone graft resorption and no radiolucent line or osteolysis was observed around the cup on the last follow-up (three years and two months after the fracture operation) radiograph. In addition, the radiolucent line located at the superior margin of the acetabular cup had disappeared. (Fig. 8C, D).

Fig. 7. Immediate postoperative radiographs show a concentric reduction with two fixed posterior plates. The bone defect in the superior and medial portion of the acetabular cup was filled with morselized bone from the femoral head allograft.
Fig. 8. (A, B) Follow-up radiographs at three months postoperatively show successful bony union and osteointegration of the acetabular component. (C, D) The last follow-up radiographs at three years and two months after the fracture operation show no osteolysis around the acetabular cup and no bone graft resorption and the radiolucent line located at the superior margin of the acetabular cup had disappeared.

Informed consent was obtained from each patient prior to submission of this study.

Occurrence of a periprosthetic acetabular fracture after THA is rare compared to a periprosthetic femur fracture. While the Vancouver system has been established for classification of periprosthetic femur fractures5,6), several systems for classifying acetabulum have been proposed. In 1996, Peterson and Lewallen3) defined periprosthetic acetabular fractures based on radiographic implant stability (stable vs. unstable cup). In 1999, in an in vitro human cadaveric study, Callaghan et al.7), who classified periprosthetic intraoperative acetabular fractures based on anatomical location, defined type A as anterior wall, type B as transverse, type C as inferior lip, and type D as posterior wall fractures. They reported that most fractures were of the peripheral type7).

Della Valle et al.8), who proposed a comprehensive classification system in 2003, considering the time of fracture (intraoperative – cup insertion vs. removal), implant stability, etiology (trauma vs. spontaneous), and osteolysis, provided details on five types and corresponding treatment strategies. Other classification systems were proposed later, including the United Classification System (UCS) in 20149), which considers the relationship between the implant and bone and implant stability. In 2018, Pascarella et al.10) proposed a classification system that considers fracture time (intraoperative vs. postoperative period) and implant stability. Many classification systems based on achieving bone union with a stable implant and congruent joint status have been proposed.

A ‘displaced fracture but a stable cup’ pattern was demonstrated in both cases. Therefore, osteosynthesis without cup revision was sufficient. Intraoperative assessment of implant stability after fracture reduction is important. Compared to high-energy trauma events in younger individuals, consideration of implant stability is required for osteoporotic patients with poor bone stock. Preoperative CT is essential for assessment of bone ingrowth. The defect site must be assessed intraoperatively and compared with preoperative imaging to assist surgeons in determining whether revision of the cup or only bone grafting is required. Postoperative administration of anabolic agents such as teriparatide may support fracture healing in patients with poor bone stock and osteoporosis11,12).

This rare complication may occur after THA. Assessment of implant stability, bone stock status, fracture pattern, and timing by surgeons is necessary for determining the optimal treatment plan, with a goal of successful bone union with a stable implant and congruent joint status. The final decisions regarding cup revision must include preoperative CT and comprehensive evaluation of operating room findings.

Although cup revision with fixation could be considered in these two cases, revision of an acetabular fracture of the posterior column could be difficult due to pelvic discontinuity. In the second case, fracture fixation and a bone graft without cup revision would be easier than a cup revision with fixation. A cup revision can be performed as a second-stage surgery in cases involving loosening of the cup during the follow-up period. However, successful bone union without cup loosening was observed during the follow-up period in both cases. In addition, a follow-up X-ray showed that the superior portion of the cup, which was de-bonded from the host bone after the fracture, was re-bonded to the cup. Open reduction with internal fixation should be considered as the first treatment option in cases where spot welding of the cup to the host bone is observed.

Kyung-Soon Park has been an editorial board member since January 2024, but had no role in the decision to publish this article. No potential conflict of interest relevant to this article was reported.

  1. McElfresh EC, Coventry MB. Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am 1974;56:483-92.
    Pubmed CrossRef
  2. Helfet DL, Ali A. Periprosthetic fractures of the acetabulum. Instr Course Lect 2004;53:93-8.
    Pubmed CrossRef
  3. Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 1996;78:1206-13. https://doi.org/10.2106/00004623-199608000-00011.
    Pubmed CrossRef
  4. Park KS, Chan CK, Lee GW, Ahn HW, Yoon TR. Outcome of alternative approach to displaced acetabular fractures. Injury 2017;48:388-93. https://doi.org/10.1016/j.injury.2016.11.029.
    Pubmed CrossRef
  5. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
    Pubmed CrossRef
  6. Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004;420:80-95. https://doi.org/10.1097/00003086-200403000-00012.
    Pubmed CrossRef
  7. Callaghan JJ, Kim YS, Pederson DR, Brown TD. Periprosthetic fractures of the acetabulum. Orthop Clin North Am 1999;30:221-34. https://doi.org/10.1016/s0030-5898(05)70077-8.
    Pubmed CrossRef
  8. Della Valle CJ, Momberger NG, Paprosky WG. Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 2003;52:281-90.
    Pubmed
  9. Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 2014;96-B:713-6. https://doi.org/10.1302/0301-620X.96B6.34040.
    Pubmed CrossRef
  10. Pascarella R, Sangiovanni P, Cerbasi S, et al. Periprosthetic acetabular fractures: a new classification proposal. Injury 2018;49 Suppl 3:S65-73. https://doi.org/10.1016/j.injury.2018.09.061.
    Pubmed CrossRef
  11. Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003;349:1216-26. https://doi.org/10.1056/NEJMoa035725.
    Pubmed CrossRef
  12. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001;344:1434-41. https://doi.org/10.1056/NEJM200105103441904.
    Pubmed CrossRef

Article

Case Report

Hip Pelvis 2024; 36(2): 155-160

Published online June 1, 2024 https://doi.org/10.5371/hp.2024.36.2.155

Copyright © The Korean Hip Society.

Periprosthetic Acetabular Fracture after Total Hip Arthroplasty: A Report on Two Cases

Joonkyoo Kang, MD , Chan Young Lee, MD , Taek-Rim Yoon, MD, PhD , Kyung-Soon Park, MD, PhD

Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

Correspondence to:Kyung-Soon Park, MD, PhD https://orcid.org/0000-0002-5036-1803
Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea
E-mail: chiasma@hanmail.net

Received: October 12, 2023; Revised: December 11, 2023; Accepted: December 11, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report two cases of postoperative total hip arthroplasty periprostehtic fracture of the acetabulum which treated by open reduction with internal fixation without acetabular cup revision. From these cases, we should consider open reduction with internal fixation as the first treatment option in cases where spot welding of the cup to the host bone is observed.

Keywords: Total hip arthroplasty, Periprosthetic fracture, Acetabulum

BODY

Periprosthetic fracture of the acetabulum after total hip arthroplasty (THA) is rare. Although the precise incidence is unknown, an incidence of 0.07%-0.8% of patients undergoing THA has been reported1-3). The number of THAs performed has shown a steady increase with increasing life expectancy. By contrast, an increase in vehicle-related high-energy traumas, along with an osteoporotic elderly population have contributed to an increase in the incidence of periprosthetic fracture after THA. Thus, the importance of this rare but challenging fracture has increased.

Periprosthetic fracture of the acetabulum is classified according to implant stability, bone stock status, fracture pattern, and time (intraoperative vs. postoperative). The goal of treatment is to achieve bone union with a stable implant and congruent joint status, which can be challenging for most orthopedic surgeons due to the rarity of the condition and treatment requires a high level of osteosynthesis and hip arthroplasty skills. We report on two cases of periprosthetic acetabular fracture after primary THA that were treated successfully with osteosynthesis without cup revision.

CASE REPORT

1. Case 1

A 46-year-old female patient underwent simultaneous bilateral primary THA with ceramic-on-ceramic articulation for treatment of osteoarthritis due to the sequelae of developmental dysplasia of the hip. No notable complications were observed during outpatient follow-up until six years post-surgery. The patient presented to our hospital’s emergency room due to a vehicle rollover accident without collision. Radiographs showed a right THA periprosthetic fracture of the acetabular component (Fig. 1). Although the posterior column of an acetabulum fracture with cup medial displacement was identified, computed tomography (CT) showed no osteolysis and spot welding was observed at the inferior and posterior cup margin (Fig. 2).

Figure 1. (A) An anteroposterior radiograph of the pelvis shows a right total hip arthroplasty periprosthetic fracture of the acetabular component and medial displacement of the acetabular cup. (B) The iliac oblique view shows a disrupted ilioischial line. Arrows: spot welding.
Figure 2. (A) Computed tomography (CT) axial view shows spot welding at the posterior cup. (B) CT coronal view shows spot welding at the inferior portion of the cup. (C) CT sagittal view shows disruption of the posterior column around the acetabular component. Arrows: spot welding.

Concentric reduction of the acetabular posterior column was achieved by wiring through the greater sciatic notch4). Additional posterior plating was performed for the posterior column (Fig. 3A, B). After two months of non-weight bearing following fixation surgery, the patient was allowed partial weight bearing. At three months after surgery, complete union of the fracture was observed, and the patient was able to walk freely. The patient is currently (seven years and seven months after the fracture operation) under observation and has not experienced any complications. In addition, no radiolucent line was observed around the acetabular component at the last follow up (Fig. 3C, D).

Figure 3. (A, B) Immediate postoperative radiographs show concentric acetabular posterior column reduction with wiring and additional posterior plating. (C, D) The last follow-up radiographs at seven years and seven months after the fracture operation show successful bony union and no osteolysis.

2. Case 2

A 67-year-old female patient underwent primary THA with ceramic-on-ceramic articulation for treatment of a left displaced femoral neck fracture. Multiple osteoporotic compression fractures were detected at the lumbar vertebra during the preoperative evaluation and measurement of bone mineral density indicated severe osteoporosis, with an L1-L4 T-score of –3.1 despite receiving oral bisphosphonate (Risedronate and Actonel) therapy for several years. The patient returned to previous household ambulatory activity levels a few months after surgery, and successful osteointegration of the THA was confirmed on the final follow-up radiograph (four years after the operation).

The patient presented to a local clinic 10.5 years after surgery for left hip pain after a slip down. A radiograph showed a left THA-related periprosthetic fracture of the acetabular component. Diffuse radiolucency was observed around the posterior column of the acetabular cup and medial cup displacement was also observed (Fig. 4). Conservative management was initially attempted at another hospital, however, the patient complained of sustained pain and presented to our hospital. A follow-up radiograph after one month showed increased medial displacement of the acetabular component (Fig. 5). Callus formation, no bone bridge formation, and a bone defect were observed around the superior and medial portions of the acetabular cup on CT (Fig. 6).

Figure 4. An initial radiograph taken at another hospital the patient visited after slipping shows a left total hip arthroplasty periprosthetic fracture of the acetabular component with medial displacement.
Figure 5. (A) A radiograph taken after one month of conservative treatment shows increased medial displacement of the acetabular component. (B) The iliac oblique view shows a disrupted ilioischial line and subluxation of the ceramic head. Arrow: spot welding.
Figure 6. (A-C) Computed tomography shows callus formation around the fracture site with no bone bridge formation and bone defects around the superior and medial portions of the acetabular cup. Arrowheads: callus formation, arrow: spot welding.

Intraoperatively, although bone ingrowth was partially maintained, bone defects were observed at the superior and medial portions of the acetabulum after reduction of the fracture. Two posterior plates were fixed, and the bone defect site was filled with a femoral head allograft (Fig. 7). The patient was instructed to use a wheelchair and to avoid weight-bearing activity and subcutaneous injections of teriparatide (Forsteo; Lilly) were prescribed for three months. Successful bony union and osteointegration of the acetabular component were observed on a radiograph taken three months after surgery (Fig. 8A, B). A congruent joint state without bone graft resorption and no radiolucent line or osteolysis was observed around the cup on the last follow-up (three years and two months after the fracture operation) radiograph. In addition, the radiolucent line located at the superior margin of the acetabular cup had disappeared. (Fig. 8C, D).

Figure 7. Immediate postoperative radiographs show a concentric reduction with two fixed posterior plates. The bone defect in the superior and medial portion of the acetabular cup was filled with morselized bone from the femoral head allograft.
Figure 8. (A, B) Follow-up radiographs at three months postoperatively show successful bony union and osteointegration of the acetabular component. (C, D) The last follow-up radiographs at three years and two months after the fracture operation show no osteolysis around the acetabular cup and no bone graft resorption and the radiolucent line located at the superior margin of the acetabular cup had disappeared.

Informed consent was obtained from each patient prior to submission of this study.

DISCUSSION

Occurrence of a periprosthetic acetabular fracture after THA is rare compared to a periprosthetic femur fracture. While the Vancouver system has been established for classification of periprosthetic femur fractures5,6), several systems for classifying acetabulum have been proposed. In 1996, Peterson and Lewallen3) defined periprosthetic acetabular fractures based on radiographic implant stability (stable vs. unstable cup). In 1999, in an in vitro human cadaveric study, Callaghan et al.7), who classified periprosthetic intraoperative acetabular fractures based on anatomical location, defined type A as anterior wall, type B as transverse, type C as inferior lip, and type D as posterior wall fractures. They reported that most fractures were of the peripheral type7).

Della Valle et al.8), who proposed a comprehensive classification system in 2003, considering the time of fracture (intraoperative – cup insertion vs. removal), implant stability, etiology (trauma vs. spontaneous), and osteolysis, provided details on five types and corresponding treatment strategies. Other classification systems were proposed later, including the United Classification System (UCS) in 20149), which considers the relationship between the implant and bone and implant stability. In 2018, Pascarella et al.10) proposed a classification system that considers fracture time (intraoperative vs. postoperative period) and implant stability. Many classification systems based on achieving bone union with a stable implant and congruent joint status have been proposed.

A ‘displaced fracture but a stable cup’ pattern was demonstrated in both cases. Therefore, osteosynthesis without cup revision was sufficient. Intraoperative assessment of implant stability after fracture reduction is important. Compared to high-energy trauma events in younger individuals, consideration of implant stability is required for osteoporotic patients with poor bone stock. Preoperative CT is essential for assessment of bone ingrowth. The defect site must be assessed intraoperatively and compared with preoperative imaging to assist surgeons in determining whether revision of the cup or only bone grafting is required. Postoperative administration of anabolic agents such as teriparatide may support fracture healing in patients with poor bone stock and osteoporosis11,12).

This rare complication may occur after THA. Assessment of implant stability, bone stock status, fracture pattern, and timing by surgeons is necessary for determining the optimal treatment plan, with a goal of successful bone union with a stable implant and congruent joint status. The final decisions regarding cup revision must include preoperative CT and comprehensive evaluation of operating room findings.

Although cup revision with fixation could be considered in these two cases, revision of an acetabular fracture of the posterior column could be difficult due to pelvic discontinuity. In the second case, fracture fixation and a bone graft without cup revision would be easier than a cup revision with fixation. A cup revision can be performed as a second-stage surgery in cases involving loosening of the cup during the follow-up period. However, successful bone union without cup loosening was observed during the follow-up period in both cases. In addition, a follow-up X-ray showed that the superior portion of the cup, which was de-bonded from the host bone after the fracture, was re-bonded to the cup. Open reduction with internal fixation should be considered as the first treatment option in cases where spot welding of the cup to the host bone is observed.

Funding

No funding to declare.

Conflict of Interest

Kyung-Soon Park has been an editorial board member since January 2024, but had no role in the decision to publish this article. No potential conflict of interest relevant to this article was reported.

Fig 1.

Figure 1.(A) An anteroposterior radiograph of the pelvis shows a right total hip arthroplasty periprosthetic fracture of the acetabular component and medial displacement of the acetabular cup. (B) The iliac oblique view shows a disrupted ilioischial line. Arrows: spot welding.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 2.

Figure 2.(A) Computed tomography (CT) axial view shows spot welding at the posterior cup. (B) CT coronal view shows spot welding at the inferior portion of the cup. (C) CT sagittal view shows disruption of the posterior column around the acetabular component. Arrows: spot welding.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 3.

Figure 3.(A, B) Immediate postoperative radiographs show concentric acetabular posterior column reduction with wiring and additional posterior plating. (C, D) The last follow-up radiographs at seven years and seven months after the fracture operation show successful bony union and no osteolysis.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 4.

Figure 4.An initial radiograph taken at another hospital the patient visited after slipping shows a left total hip arthroplasty periprosthetic fracture of the acetabular component with medial displacement.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 5.

Figure 5.(A) A radiograph taken after one month of conservative treatment shows increased medial displacement of the acetabular component. (B) The iliac oblique view shows a disrupted ilioischial line and subluxation of the ceramic head. Arrow: spot welding.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 6.

Figure 6.(A-C) Computed tomography shows callus formation around the fracture site with no bone bridge formation and bone defects around the superior and medial portions of the acetabular cup. Arrowheads: callus formation, arrow: spot welding.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 7.

Figure 7.Immediate postoperative radiographs show a concentric reduction with two fixed posterior plates. The bone defect in the superior and medial portion of the acetabular cup was filled with morselized bone from the femoral head allograft.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

Fig 8.

Figure 8.(A, B) Follow-up radiographs at three months postoperatively show successful bony union and osteointegration of the acetabular component. (C, D) The last follow-up radiographs at three years and two months after the fracture operation show no osteolysis around the acetabular cup and no bone graft resorption and the radiolucent line located at the superior margin of the acetabular cup had disappeared.
Hip & Pelvis 2024; 36: 155-160https://doi.org/10.5371/hp.2024.36.2.155

References

  1. McElfresh EC, Coventry MB. Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am 1974;56:483-92.
    Pubmed CrossRef
  2. Helfet DL, Ali A. Periprosthetic fractures of the acetabulum. Instr Course Lect 2004;53:93-8.
    Pubmed CrossRef
  3. Peterson CA, Lewallen DG. Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 1996;78:1206-13. https://doi.org/10.2106/00004623-199608000-00011.
    Pubmed CrossRef
  4. Park KS, Chan CK, Lee GW, Ahn HW, Yoon TR. Outcome of alternative approach to displaced acetabular fractures. Injury 2017;48:388-93. https://doi.org/10.1016/j.injury.2016.11.029.
    Pubmed CrossRef
  5. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
    Pubmed CrossRef
  6. Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004;420:80-95. https://doi.org/10.1097/00003086-200403000-00012.
    Pubmed CrossRef
  7. Callaghan JJ, Kim YS, Pederson DR, Brown TD. Periprosthetic fractures of the acetabulum. Orthop Clin North Am 1999;30:221-34. https://doi.org/10.1016/s0030-5898(05)70077-8.
    Pubmed CrossRef
  8. Della Valle CJ, Momberger NG, Paprosky WG. Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 2003;52:281-90.
    Pubmed
  9. Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 2014;96-B:713-6. https://doi.org/10.1302/0301-620X.96B6.34040.
    Pubmed CrossRef
  10. Pascarella R, Sangiovanni P, Cerbasi S, et al. Periprosthetic acetabular fractures: a new classification proposal. Injury 2018;49 Suppl 3:S65-73. https://doi.org/10.1016/j.injury.2018.09.061.
    Pubmed CrossRef
  11. Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003;349:1216-26. https://doi.org/10.1056/NEJMoa035725.
    Pubmed CrossRef
  12. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001;344:1434-41. https://doi.org/10.1056/NEJM200105103441904.
    Pubmed CrossRef

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