Research in practice: Complex revision surgery for postoperative hip dislocation and acetabular fracture

One week after a female patient in her mid-70s underwent a total hip arthroplasty (THA) she was referred to Mayo Clinic due to early complications of a postoperative hip dislocation and acetabular fracture.

Complexity

Because postoperative dislocation occurred so early, re-operating posed additional stress of surgery and risk of infection. A second challenge existed in the simultaneous need to repair the pelvic disassociation sustained during the dislocation event.

Solution

In a single surgery, the team took a posterior approach to the hip, removed the nonosseointegrated cup, repaired the pelvic disassociation fracture, reconstructed the socket with a highly cross-linked polyethylene (HXLPE) acetabular component, and cemented the HXLPE shell and reduced the hip.

Outcome

The patient recovered uneventfully. At two-year follow-up she was free of pain and the hip remained stable. Robert T. Trousdale, M.D., of Mayo Clinic in Rochester, Minn., and lead orthopedic surgeon on the case, comments: "In THA, the failure of a component to osseointegrate holds enormous potential to layer on even more serious disability, such as the broken pelvis in this case. The fact that we have subspecialists in both hip and pelvic repairs positioned us to handle multiple repairs routinely. An added benefit of Mayo orthopedic care is our research base and Total Joint Registry, because its evidence guides clinical decision-making regarding component use, survivorship and wear characteristics."

The research base

In May 2013, Dr. Trousdale and Mayo colleagues authored one of the largest, long-term studies ever published on the wear aspects and durability of HXLPE implants — particularly in younger patients, since national trends document an emerging need for hip repairs in patients younger than the average age of 66 years.

Based on data from Mayo Clinic Total Joint Registry, the study followed 54 THA procedures performed at Mayo Clinic between 1999 and 2002 in patients ages 15 to 50 (average 38.9 years). They were followed for a minimum of 10 years. Results show HXLPE implants produced excellent fixation and survivorship, with lower wear rates than conventional polyethylene, even in the younger, presumably more active, patients.

For more information

Babovic N, et al. Total hip arthroplasty using highly cross-linked polyethylene in patients younger than 50 years with minimum 10-year follow-up. The Journal of Arthroplasty. 2013;285:815.

Feb. 11, 2014