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Órgano de difusión del Servicio de Sanidad Militar y del Colegio Nacional de Médicos Militares

2018, Number 2

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Rev Sanid Milit Mex 2018; 72 (2)

Complication of a bilateral acetabular fracture after multiple surgeries and 30 years of evolution. Presentation of a case

Velutini BR, Azcona CA, Velutini KJA

Language: Spanish
References: 37
Page: 141-147
PDF size: 249.72 Kb.


ABSTRACT

Bilateral acetabular fracture, open reduction and internal fixation, without achieving anatomical reduction; it required placement of short-term total prostheses, both cemented. We made a revision of both left hip components in the eighth year because of loosening of the cup and stem, with uncemented components. The femur evolved satisfactorily, but the acetabulum required six subsequent revisions, with bone grafts and placement of metal reinforcements, initially very stable, but with screw rupture and lack of osseointegration of both implants and grafts at 12 and 18 months in the different surgical events. She developed pseudoaneurysm of the left external iliac artery, treated by a vascular surgeon; it got complicated with local infection first and later, deep infection of the left hip by Staphylococcus aureus. The implants were removed from the iliac and polymethylmethacrylate with antibiotics was used to fill the large bone defect while the infection was being controlled, ending with a saddle rescue prosthesis (Link, Hamburg). It currently has a good function, without pain, but with limited mobility, especially flexion. The right hip has only been checked once; the acetabular cup began to migrate cephalically and vertically, but without losing stability, shortly after the loosening of the left one; it never developed femoral stem involvement, allowing acceptable function and being «her good leg» during the time of the left hip dysfunction. It was reviewed by placing a structural bone graft with two femoral heads from a corpse and cementing a new cup. The patient’s recovery has been very good, returning to an active life in which she is self-sufficient in all her daily activities; uses a crutch with her right hand, drives a van, is pain-free.


REFERENCES

  1. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996; 78 (11): 1632-1645.

  2. Leturnel E, Judet R. Fractures of the acetabulum. 2nd ed. Berlin: Springer-Verlag; 1993. pp. 521-581.

  3. Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res. 1994; (305): 31-37.

  4. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res. 2003; (407): 173-186.

  5. Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012; 94 (17): 1559-1567.

  6. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2013; 21 (3): 128-139.

  7. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988; (232): 26-36.

  8. Leunig M, Siebenrock KA, Ganz R. Rationale of periacetabular osteotomy and background work. J Bone Joint Surg Am. 2001; 83: 438-448.

  9. Shannon BD, Trousdale RT. Femoral osteotomies for avascular necrosis of the femoral head. Clin Orthop Relat Res. 2004; (418): 34-40.

  10. Aronson J. Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect. 1986; 35: 119-128.

  11. Sembrano JN, Cheng EY. Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res. 2008; 466 (7): 1657-1665.

  12. Beckmann NA, Weiss S, Klotz MC, Gondan M, Jaeger S, Bitsch RG. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty. 2014; 29 (1): 229-235.

  13. Buchholz HW, Elson RA, Engelbrecht E, Lodenkämper H, Röttger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981; 63-B (3): 342-353.

  14. Reunión de Consenso Internacional sobre Infecciones Articulares Periprotésicas. Acta Ortop Mex. 2013; 27 (S1).

  15. Richard MJ, Creevy WR, Tornetta P. The use of solid form-fitting antibiotic cement spacers in bone loss of the lower extremity. Curr Orthop Prac. 2012; 23 (5): 453-457.

  16. Hsieh PH, Huang KC, Tai CL. Liquid gentamicin in bone cement spacers: in vivo antibiotic release and systemic safety in two-stage revision of infected hip arthroplasty. J Trauma. 2009; 66 (3): 804-808.

  17. D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989; (243): 126-137.

  18. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994; 9 (1): 33-44.

  19. Hofmann AA, Goldberg TD, Tanner AM, Cook TM. Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip. J Arthroplasty. 2005; 20 (7): 874-879.

  20. Durbhakula SM, Czajka J, Fuchs MD, Uhl RL. Spacer endoprosthesis for the treatment of infected total hip arthroplasty. J Arthroplasty. 2004; 19 (6): 760-767.

  21. Nieder E, Keller A. The saddle prosthesis Mark II, Endo-Modell. In: Yamamuro T (Ed.). New developments for limb salvage in musculoskeletal tumors. Berlin: Springer-Verlag; 1989. pp. 481-490.

  22. Nieder E, Elson RA, Engelbrecht E, Kasselt MR, Keller A, Steinbrink K. The saddle prosthesis for salvage of the destroyed acetabulum. J Bone Joint Surg Br. 1990; 72 (6): 1014-1022.

  23. Garbuz D, Morsi E, Gross AE. Revision of the acetabular component of a total hip arthroplasty with a massive structural allograft. Study with a minimum five-year follow-up. J Bone Joint Surg Am. 1996; 78 (5): 693-697.

  24. Morsi E, Garbuz D, Gross AE. Revision total hip arthroplasty with shelf bulk allografts. A long-term follow-up study. J Arthroplasty. 1996; 11 (1): 86-90.

  25. Sporer SM, O’Rourke M, Chong P, Paprosky WG. The use of structural distal femoral allografts for acetabular reconstruction. Average ten-year follow-up. J Bone Joint Surg Am. 2005; 87 (4): 760-765.

  26. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51 (4): 737-755.

  27. Dorr LD, Kane TJ 3rd, Conaty JP. Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study. J Arthroplasty. 1994; 9 (5): 453-456.

  28. Sullivan PM, MacKenzie JR, Callaghan JJ, Johnston RC. Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twenty-two-year follow-up study. J Bone Joint Surg Am. 1994; 76 (6): 863-869.

  29. Takenaga RK, Callaghan JJ, Bedard NA, Liu SS, Klaassen AL, Pedersen DR. Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up. J Bone Joint Surg Am. 2012; 94 (23): 2153-2159.

  30. Jain S, Grogan RJ, Giannoudis PV. Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review. Hip Int. 2014; 24 (2): 109-122.

  31. Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up. J Bone Joint Surg Am. 1997; 79 (2): 159-168.

  32. Piriou P, Sagnet F, Norton MR, de Loubresse CG, Judet T. Acetabular component revision with frozen massive structural pelvic allograft: average 5-year follow-up. J Arthroplasty. 2003; 18 (5): 562-569.

  33. Ristiniemi J, Lakovaara M, Flinkkilä T, Jalovaara P. Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss: 22 of 23 fractures healed after 5-20 months. Acta Orthop. 2007; 78 (4): 520-527.

  34. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004; 86-A (9): 1989-1997.

  35. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res. 2003; (407): 173-186.

  36. Saleh KJ. Artrosis y artroplastia: la cadera. En: Mears DC. Artoplastia total de cadera después de una fractura acetabular. Caracas, Venezuela: Ed. Amolca; 2013 (18): 171-187.

  37. Jimenez ML, Tile M, Schenk RS. Total hip replacement after acetabular fracture. Orthop Clin North Am. 1997; 28 (3): 435-446.




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