Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture

Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management.

We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59 years (20-94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5 years (2-13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d'Aubigné (PMA) scores and Brooker classification.

The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (β = -4.2), HHS (β = -7.8), and PMA (β = -2.2) scores at mean 5 years (2-13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10 years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p < 0.001).

Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10 years in a medically vulnerable patient population.

Level 3; Therapeutic study.