Functional outcome of acute primary total hip replacement after complex acetabular fractures

To assess the functional outcome of acute primary total hip replacement in the management of complex acetabular fractures.

This prospective observational study was conducted in orthopedic department of Liaquat National Hospital and Medical College, Karachi. The study was approved by the Ethics review committee of hospital (0190-2016). Patients who encountered between January 2010 to January 2016 were entered. Fifty-four patients with acetabular fractures with certain indications (marginal impaction or significant comminution (> 3 fragments) of the articular surface of the acetabulum, full-thickness articular injury to the femoral head, an associated femur neck fracture, or preexisting symptomatic osteoarthritis) were treated with primary total hip replacement. Patients were followed in outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications. Functional outcome was evaluated after 2 years by applying Harris Hip Score. All statistical analysis was done by using SPSS version 20.

All patients achieved radiological union of fractures at an average duration of 21 weeks. During the follow-up, seven complications were observed. Two patients developed superficial surgical site infection which was treated conservatively. One patient had dislocation which was reduced closely, while two patients had acetabular cup loosening which was revised. We also observed two cases of Brooker I heterotopic ossification and one case of Brooker II. At 2-year follow-up, 78% of patients had an excellent and good functional outcome according to Harris Hip score.

Primary total hip replacement is a valid and reasonable one stage surgical treatment of complex acetabular fractures and in aged individuals. However, the complications are not uncommon.