외상성 관절염과 퇴행성 관절염에서의 고관절 전치환술의 비교

초록

Total hip arthroplasty has an important role in the management of acerabular fracture. Secondary complicating factors may be encountered during the THA. After initial non-surgical treatment of an acetabular fracture, an occult or frank acetabular nonunion and malunion are not uncommon. After surgical treatment, intrusive hardware, heterotopic bone, dens scar tissue, ischemic muscle or bone and occult infection are additional hazards. When acute sciatic nerve palsy accompanies the initial acetabular injury, the palsy is likely to be exacerbated during a subsequent THA. Evaluation of results has shown that, overall, the late outcome of THA after acetabular fracture is inferior to that of arthroplasty performed because of degenerative arthritis. Although open reduction and internal fixation of an acute acetabular fracture was previously hypothesized as an effective way to improve the anticipated late outcome of THA by the elimination of a large fracture gap or the prevention of a potential nonunion, current observations do not support that hypothesis. An initial open reduction may compromise the outcome of a subsequent THA by compromising the blood supply of the acetabulum and by initiating the formation of scar tissue, heterotopic bone, or an occult or frank infection. For a highly selected group of especially severe actabular fractures, particularly those in elderly patients, THA appears to be a promising therapeutic alternative.