Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating

Eur J Trauma Emerg Surg. 2022 Aug;48(4):3185-3192. doi: 10.1007/s00068-021-01872-0. Epub 2022 Jan 17.


Purpose: A common surgical treatment in anterior column acetabular fractures with preexisting osteoarthritis is THA, which is commonly combined with plate osteosynthesis. Implantation of a solitary revision cup cranially fixed to the os ilium is less common. The purpose of this study was to compare the stabilization of anterior column acetabular fractures fixed with a cranial socket revision cup with flange and iliac peg or with a suprapectineal plate osteosynthesis combined with an additional revision cup.

Methods: In 20 human hemipelves, an anterior column fracture was stabilized by either a cranial socket revision cup with integrated flange (CF = Cup with Flange) or by a suprapectineal plate combined with a revision cup (CP = Cup and Plate). Each specimen was loaded under a stepwise increasing dynamic load protocol. Initial construct stiffness, interfragmentary movements along the fracture line, as well as femoral head movement in relation to the acetabulum were analyzed.

Results: Both groups showed comparable initial construct stiffness (CP: 3180 ± 1162 N/mm and CF: 3754 ± 668 N/mm; p = 0.158). At an applied load of 1400 N, interfragmentary movements at the acetabular (p = 0.139) and the supraacetabular region (p = 0.051) revealed comparable displacement for both groups and remained below 1 mm. Femoral head movement in relation to the acetabulum also remained below 1 mm for both test groups (p = 0.260).

Conclusion: From a biomechanical point of view, both surgical approaches showed comparable fracture reduction in terms of initial construct stiffness and interfragmentary movement. The potential benefit of the less-invasive cranial socket revision cup has to be further investigated in clinical studies.

Keywords: Acetabular fracture; Acute total hip arthroplasty; Anterior column; Biomechanics; Revision cup; Suprapectineal plate.

MeSH terms

  • Acetabulum / injuries
  • Acetabulum / surgery
  • Arthroplasty, Replacement, Hip* / methods
  • Biomechanical Phenomena
  • Fracture Fixation, Internal / methods
  • Fractures, Bone* / surgery
  • Hip Fractures* / surgery
  • Humans
  • Spinal Fractures* / surgery