William G. Hamilton
ORLANDO — New data suggests using a systematic approach to recognize patients with acetabular fractures who would benefit from undergoing total hip arthroplasty, according to a presenter at the Current Concepts of Joint Replacement Winter Meeting.
Although elderly patients with acetabular fractures but good bone quality and no joint impaction may experience good results when treated with THA, William G. Hamilton, MD, said that published literature has shown poor results at 5-year follow-up in patients older than age 60 years.
“Nonoperative treatment can be used in patients who are medically unsafe, those non-ambulatory with minimally or non-displaced fractures and delayed treatment in those patients that are not medically optimized or have concomitant injuries can be utilized as well,” Hamilton said in his presentation.
He added that acute THA for the treatment of acetabular fractures is appropriate for medically stable patients and patients with fracture patterns likely to result in failed open reduction and internal fixation, such as older patients, patients with intra-articular comminution, severe osteopenia and pre-existing arthritis.
Hamilton noted that surgeons should use a surgical approach they are most comfortable with and consider where the hardware is located and if it needs to be removed. Heterotopic ossification is also a concern and surgeons should consider removing it if it is in the way or causing pain or stiffness, according to Hamilton.
“How do you prevent [heterotopic ossification]? Traditionally, we have had a long heritage of using external beam radiation at our institution,” Hamilton said. “More recently, with the data on NSAIDs combined with the fact that I am already giving patients NSAIDs around the time of surgery, I have been using this more frequently as my role of the technique of [heterotopic ossification] HO prophylaxis.” – by Casey Tingle
Hamilton WG. Acetabular fx’s in the young and elderly. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Hamilton reports he receives consulting fees and royalties for consulting and product design from DePuy Synthes and Total Joint Orthopedics.