Total hip arthroplasty for posttraumatic osteoarthritis secondary to acetabular fracture: An evidence based on 1,284 patients from 1970 to 2018

The unexpected role of B vitamins in osteoarthritis: a call for caution

Background: The purpose of this study was to investigate the single and mixed effects of B vitamins on OA. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) database, from 2003 to 2018, were extracted. A weighted multiple logistic regression model was used to assess the association between B vitamin intake alone and OA. In addition, Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression and quantile g-calculation (qgcomp) models were used to evaluate the combined effects of six B vitamins on OA. Additionally, restricted cubic spline (RCS) was used to assess possible nonlinear associations between individual B vitamins and OA. Results: The study found that vitamin B1 (OR = 1.17, 95%CI = 1.05-1.30), vitamin B2 (OR = 1.12, 95%CI = 1.02-1.22), vitamin B12 (OR = 1.01, 95%CI = 1.00-1.01) and total folate (OR = 1.001, 95%CI = 1.000-1.001) increased the risk of OA. Subgroup analysis showed that the association was more significant in people older than 65 and in women. In addition, the mixed effect model also suggested that the mixed effect of six B vitamin mixtures on OA risk was greater. Among them, vitamin B2 and vitamin B12 contributed the most to the promotion of OA disease by B-complex vitamins. Folic acid, however, showed a protective effect on the bone and joints in the mixed effect model. Conclusion: The data show that the intake of B vitamins accelerates the occurrence and progression of OA. People with OA disease and those at high risk should be cautious about using vitamin B as a dietary supplement.

Risk factors for post-traumatic osteoarthritis and subsequent total hip arthroplasty in patients with acetabular fractures

BACKGROUND

Post-traumatic osteoarthritis (PTOA) often develops after acetabular fractures, leading to a need for total hip arthroplasty (THA). This study aimed to identify the risk factors associated with PTOA and subsequent THA among patients with acetabular fractures treated with open reduction and internal fixation (ORIF).

METHODS

The records of patients with closed acetabular fractures treated at a tertiary care medical center in Taiwan from 2002 to 2019 were retrospectively reviewed. Eligibility criteria were patients who underwent ORIF with a minimum follow-up of 2 years. The primary outcomes were occurrence of PTOA and subsequent THA. Multivariate logistic regression was employed to identify significant factors associated with PTOA and THA.

RESULTS

A total of 54 patients were included, with a mean age of 41.4 years and 76% were male (n = 41). PTOA occurred in 28 patients (52%), and 13 patients (24%) required THA. Advanced age (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI]: 1.00-1.10, p = 0.035) and a both column fracture (aOR = 12.80, 95% CI: 2.21-74.16, p = 0.004) were significant predictors of PTOA. Time to ORIF (aOR = 1.36, 95% CI: 1.06-1.75, p = 0.018) and unsatisfactory Matta criteria (aOR = 7.62, 95% CI: 1.30-44.58, p = 0.024) were significant predictors for subsequent THA.

CONCLUSION

Age and fracture pattern are independent predictors of PTOA, while time to ORIF and Matta criteria are predictive of the need for THA. Early timing of ORIF could decrease the likelihood of subsequent THA, underscoring the importance of prompt surgical intervention in clinical decision-making to optimize patient outcomes. Further research is needed to refine preoperative risk stratification and clinical management strategies for patients with acetabular fractures.

Evaluation of total hip arthroplasty for management of acetabular fracture complications: A prospective cohort study

Objectives:

Total hip arthroplasty (THA) has been recommended as an effective tool for restoring joint function. This study aimed to evaluate the functional and clinical outcomes of THA management of acetabular fracture late complications such as arthritis by both Harris-Hip Score (HHS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) score, anticipate, and prevent the most common complications such as infection and dislocation.

Methods:

This prospective case series included 30 patients with THA to manage acetabular fracture complications such as arthritis. The study started in November 2021 and ended in September 2023. Inclusion criteria were patients with acetabular fractures with secondary arthritis (pre-existing osteoarthritis were excluded) aged 25– 70 and who had at least 1 year from fracture to arthroplasty. Exclusion criteria were patients with a history of previous infection.

Results:

Heterotopic ossification (HO) improved statistically significantly after using ketorolac at an 18-month follow-up compared to preoperatively. Using both the HHS and WOMAC scores, a statistically significant difference was found between pre-operative and post-operative functional outcomes for estimating HO development using radiographs.

Conclusion:

THA was safe and effective in managing late acetabular fracture complications. Ketorolac use showed promising results in prophylaxis against HO.

Total Hip Arthroplasty Following Operative Fixation of Acetabular Fracture: A Contemporary Series

BACKGROUND

Total hip arthroplasty (THA) is the operation of choice for salvage of post-traumatic arthritis following acetabular fracture. While high failure rates have been reported for these procedures, existing literature reports mainly on historical implant designs and techniques. We aimed to describe implant survivorships, complications, radiographic results, and clinical outcomes of contemporary THA following prior open reduction internal fixation (ORIF) of an acetabular fracture.

METHODS

We identified 104 patients undergoing THA following prior ORIF of an acetabular fracture from 2000 to 2015 via our institutional total joint registry. Mean age at THA was 50 years (range, 18 to 79 years), 71% were men, and mean body mass index was 27 (range, 18 to 52). All patients were implanted with uncemented acetabular components, and 89% had uncemented stems. Some hardware from prior fixation was retained in 94% of cases. Mean follow-up was 10 years (range, 2 to 21 years).

RESULTS

The 10-year survivorships free of any revision and any reoperation were 98% and 97%, respectively. There were 4 revisions: 1 each for psoas tendonitis, dislocation, acetabular aseptic loosening, and periprosthetic joint infection. There were 9 complications that did not lead to reoperation: 5 dislocations, 2 periprosthetic femur fractures, 1 sciatic nerve palsy, and 1 case of symptomatic heterotopic ossification. All unrevised components appeared radiographically well-fixed. Mean Harris Hip Score improved from mean 50 preoperatively to mean 82 at 5 years (P < .001).

CONCLUSIONS

In this series of contemporary THAs following prior acetabular fracture ORIF, revision-free survivorship was excellent with only a single case of acetabular aseptic loosening. These results are encouraging and suggest that contemporary implants and techniques have notably improved on historic results.

LEVEL OF EVIDENCE

Therapeutic, Level IV.

Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review

PURPOSE

Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP.

METHODS

PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO.

RESULTS

Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good."

CONCLUSIONS

CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes.

LEVEL OF EVIDENCE

Level of evidence IV.