Conversion to total hip arthroplasty in posttraumatic arthritis: short-term clinical outcomes

Fractures of the acetabulum are challenging and very difficult to treat, and even after fixation, they can lead to posttraumatic arthritis. Total hip arthroplasty (THA) has been the most common surgery performed for the complications of posttraumatic arthritis in this group of patients.

In this article, it is aimed to assess the functional results and complications of the conversion to THA for posttraumatic arthritis after acetabular fracture.

Forty-nine patients were followed up for a mean of 3.7 years (range 2-5 years). The complications included four cases of sciatic nerve palsy, all of which had injury during the first operation. Two cases underwent two-stage surgery because of infection which was demonstrated by a high level of erythrocyte sedimentation rate/C-reactive protein and according to frozen section samples, which were sent intraoperatively with >10 neutrophil/high-power field; one case was then managed by a one-stage protocol for infection after THA was infected with methicillin-resistant Staphylococcus aureus. In 1 case, we used the Girdlestone operation for severe infections and uncontrolled diabetes; in 2 cases, we used cages; and in 47 cases, we used uncemented cups.

The mean of modified Hip Harris Score improved from 47 (31-66) before the conversion to 89 (79-95) at the final follow-up. The pain component of the Western Ontario and McMaster Universities also increased from an average of 15 (7-20) to 4 (0-11) at the final follow-up. No dislocation, deep vein thrombosis or pulmonary thromboembolism, new nerve injury, and heterotopic ossification occurred.

The conversion to THA after posttraumatic arthritis in acetabular fracture can lead to reasonable pain relief and functional improvement.