Posterior Acetabular Augmentation for Recurrent Posterior Dislocations following a Hemiarthroplasty

Introduction: Hemiarthroplasty is a common procedure for subcapital hip fractures in the elderly. Recurrent dislocations can be a devastating complication with high rate of morbidity. On February 2007, Rajan Maheshwari and his colleagues published a unique and simple technique of acetabular augmentation to treat this complication with very good results. Over the last nine years, we implemented this technique for these challenging patients.

Methods: All patients were operated after at least two posterior dislocations. During the operation the stability of the prosthesis was examined and the neck length and head size were adjusted as needed. Posterior acetabular lip was exposed, followed by cement & screws construct augmentation. After the primary stabilization we examined again motion range and its stability. All patients were treated with abduction brace for six weeks after the surgery.

Results: Over the last nine years, we treated eight patients with this method. The average age was 80 (Range 65-92), there were six females and two males. Average time to first dislocation was less than one month, however in one patient the first dislocation occurred after one year. Most of the patients returned to their basic ADL after the surgery without mention of complications. One patient underwent an excision arthroplasty due to augmentation fracture after excessive uncontrolled movement.

Conclusion: This simple technique of posterior acetabular augmentation showed to be a successful method in the treatment of those patients. It can be added to the armamentarium in treatments of these elderly debilitated patients.