Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures.

摘要

OBJECTIVE: To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. DESIGN: Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. SETTING: Academic Level I trauma center. PARTICIPANTS: Patients who developed posttraumatic hip arthritis after nonoperatively or operatively treated acetabulum fractures. The average age of patients was twenty-nine years (range 16 to 47 years). INTERVENTION: Patients underwent an intertrochanteric osteotomy to decrease contact pressures on damaged cartilage and to lessen contractures. All intertrochanteric osteotomies at our institution were performed by the senior author (R.K.M.). MAIN OUTCOME MEASUREMENTS: The Merle d'Aubigne score and the Thompson and Epstein score were determined based on each patient's last follow-up. RESULTS: At an average long-term follow-up of 10.2 years (range 2.5 to 22 years), all eight patients had a significant improvement based on the Merle d'Aubigne score (average increase 5.3 points). Less improvement was observed according to the Thompson and Epstein score, which is consistent with the fact that radiographic appearance is weighted disproportionally in that score. CONCLUSIONS: Because most acetabular fracture patients are relatively young, the option of joint replacement for posttraumatic hip arthritis is less than ideal. However, we have observed significant improvement in hip function with a decrease in pain and disability when such patients are treated with an intertochanteric osteotomy.