Acute management of acetabular fractures by total hip arthroscopy using an anterior approach

Acetabular fractures in elderly patients present a therapeutic challenge, since their osteosynthesis may be hindered by comminution and poor bone quality. In certain cases, a good solution is acute total hip arthroplasty (THA) by direct anterior approach with or without minimal associated osteosynthesis. The objective of this study was to establish the indications and evaluate the clinical/functional, radiological results and complications, in the short and medium term, of acute THA using an anterior approach after acetabular fractures.

We analyzed 15 patients collecting: demographic data, classification of fractures, surgical data, clinical/functional and evolutionary radiographic evaluation, together with perioperative complications.

The mean follow-up of the patients was 40 months with a final functional assessment of 96.5 for Harris Hip Score, and Merle D'Aubigné excellent in 93%. The radiological controls were satisfactory without prosthetic loosening. Only 2patients presented low-grade heterotopic calcifications. Ninety-four percent of the patients presented optimal postoperative recovery, with immediate loading. There was only one death for reasons unrelated to the surgery.

Given certain acetabular fractures, acute THA using a direct anterior approach in the supine position and under scope control with a revision cup plus associated minimal osteosynthesis, if necessary, facilitates adequate fracture stabilization with full functional recovery of the patient with immediate loading and excellent results in the short and medium term with minimal complications.