High anterior column fractures may be best treated utilizing the lateral window of the ilioinguinal approach.
3. Cup removal
In the setting of infection, loosening, or osteolysis, cup removal may lead to acute bone loss and/or the creation of periprosthetic fractures. If this destabilizes the acetabular support of the arthroplasty, fracture specific reduction and fixation techniques are necessary. Depending on the fracture pattern, ORIF with plate and screw and/or column fixation may be indicated.
It is critical to remove the cup without causing additional fractures or bone defects.
Postoperative management should include careful monitoring of hematocrit and electrolytes particularly in the elderly patients.
Postoperative IV antibiotics should be administered up to 24 hours.
Consideration should be given to anticoagulation for a minimal course of 35 days. If there are thromboembolic complication this treatment is extended.
Drains can be discontinued when output is less than 30 to 50 cc per 12 hours.
Immediate mobilization of the patient should commence. If fracture stability will allow, the patient should be made weight bearing as tolerated as soon as possible. Long periods of limited weight bearing are extremely detrimental to patient recovery.
Precautions against hip dislocation
Hip precautions can be extremely important in patients who have suffered intraoperative acetabular fracture. Much work has been done to minimize the surgical exposure during hip arthroplasty to decrease the risk of dislocation. These advantages are typically removed when acetabular stabilization need to be performed. A dislocation in the postoperative course of such a patient can be disastrous.
Patients are instructed to follow standard hip precautions against dislocation based upon the surgical approaches for hip arthroplasty.
Avoidance of edema postoperatively is critical for both wound healing and patient mobilization. This can be aided by pneumatic compression devices. If negative pressure wound therapy is utilized, it can be discontinued after 5 to 7 days. Staples or sutures are typically removed at 14 to 21 days.