Total hip arthroplasty after surgical treatment of acetabular fractures : a 5-year minimum follow-up study

Total Hip Arthroplasty (THA) after acetabular fracture is a technically demanding procedure due to previous incisions, hardware presence, acetabular bone loss, residual pelvic deformity, post-traumatic osteonecrosis and high risk of infection. The objective of this study is to evaluate results of THA after post-traumatic osteoarthritis (OA) and/or hip joint avascular necrosis (AVN) secondary to acetabular fracture, with a minimum of 5 years follow up. 49 THA were performed after acetabular fractures open reduction internal fixation (ORIF) on 30 male and 19 female patients. Average age was 47.3 years (range, 25 to 73 years) at the time of THA. Time between initial acetabulum ORIF and definitive THA was on average 11 months (range 9 to 18 months). The mean follow-up period was 5.3 years (range 5 to 7 years). Harris hip score (HHS) was obtained pre and postoperatively. Removal of previous hardware was complete in 7 patients (14.2%), partial in 19 patients (38.7%). A cemented cup was implanted in 13 patients (26.5%) and an uncemented cup in 36 patients (73.5%). The mean preoperatively HHS score was 42 (range 25 to 58) and 91 after arthroplasty (range 82 to 96). Revision surgery due to aseptic loosening of the acetabular component was required in 3 cases (6.1%). Outcomes of THA after acetabular fractures previously treated with open reduction and internal fixation are acceptable at medium long-term followup. Selection of a cementless acetabular component seems to be a more predictable choice.