Primary total hip arthroplasty after acetabular fracture

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Arthroplasty

Background:

• Total hip arthroplasty (THA) following acetabular fractures often addresses secondary degenerative changes or femoral head osteonecrosis.
• Complications such as nonunion, malunion, hardware issues, heterotopic ossification, and infection can arise after initial fracture treatment.
• Pre-existing sciatic nerve palsy may be exacerbated during subsequent THA.

Purpose of the Study:

• To review the challenges and outcomes of THA after acetabular fracture.
• To highlight the importance of thorough pre-operative evaluation and surgical strategy.
• To discuss management options for bone defects and nonunions in this context.

Main Methods:

• Review of clinical and radiographic evaluations for THA post-acetabular fracture.
• Identification of necessary specialized instruments, fixation devices, and grafting materials.
• Consideration of extensile approaches for heterotopic bone removal and defect reconstruction strategies (e.g., impaction grafting, structural grafts, mesh, fixation devices).

Main Results:

• Overall late outcomes of THA after acetabular fracture are inferior to THA for degenerative arthritis.
• Initial open reduction and internal fixation does not appear to improve late THA outcomes and may compromise them.
• THA can be a promising alternative for select severe acetabular fractures, especially in elderly patients.

Conclusions:

• THA after acetabular fracture requires meticulous planning due to potential complications.
• Early surgical intervention on acetabular fractures may negatively impact subsequent THA outcomes.
• Careful patient selection and surgical strategy are paramount for successful THA in complex acetabular fracture cases.