Abstract
PURPOSE: To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures. MATERIALS: Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)). RESULTS: The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results. CONCLUSION: Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.