Late Salvage of Failed Open Reduction and Internal Fixation of Posterior Wall Fractures of the Acetabulum

Objectives: The purpose of this study was to review the outcome of late revision surgery in a series of patients with posterior wall fractures having recurrent hip instability after failed initial open reduction and internal fixation. Design: Retrospective analysis of consecutive patients. Setting: Level I trauma center. Patients: A retrospective analysis of consecutive acetabulum patients treated by a single surgeon between 1989 and 2005 identified 4 patients referred for recurrent hip instability subsequently treated by revision open reduction and internal fixation performed 3 weeks or more (range 3 weeks to 9 months) after the original injury. Intervention: Revision open reduction and internal fixation through a Kocher-Langenbeck approach. Main Outcome Measurements: Final radiographic appearance and modified Merle d'Aubigne Score. Results: Three of the 4 patients eventually required total hip arthroplasty. Two of these 3 patients required total hip arthroplasty within 18 months of revision surgery. Both, older than 50 years, had experienced catastrophic early hip redislocation associated with femoral head pathology after the original surgery. Despite progression of traumatic arthrosis, I patient continues to ambulate without assistance or pain on her native hip, 18 years after the revision open reduction and internal fixation surgery. Conclusions: Patients are likely to experience poor clinical outcome, ultimately requiring total hip arthroplasty, when salvage procedures are delayed by more than 3 weeks. In older patients, failure occurs rapidly; in younger patients, total hip replacement surgery may be delayed. Therefore, in older patients, particularly if there is concomitant damage to the femoral head, late revision fracture fixation surgery is ill advised and total hip arthroplasty seems to be the most appropriate secondary surgery. However, late revision fracture fixation surgery may provide young, active patients a limited number of years of satisfactory function before total hip arthroplasty is required.