A Neglected Fracture of Acetabulum Treated With Total Hip Replacement

Total hip replacement (THR) for osteoarthritis or inflammatory arthritis yields better outcomes than THR for patients with neglected acetabular fractures. The inferior clinical results mostly arise from an unforeseen bone deficit, making the treatment more time-consuming and complex for instances requiring acetabular restoration and bone grafting. There is a lack of research on the clinical results of THR in cases where acetabular fractures have been overlooked. A 55-year-old male patient presented with a malunited anterior column of the acetabulum, non-union of the posterior column with protrusion, and a significant impaction fracture in the femoral head. He was then treated with open reduction and internal fixation (ORIF) of acetabular columns, along with the use of a reconstruction cage and bone grafting. At the five-year follow-up, the patient had a good outcome. The keys to success include meticulous preoperative planning using radiography and computed tomography (CT) scans, sufficient exposure to define the fracture pattern, and the availability of a full range of devices and backup implants. If there are any prior implants, they should only be removed if they are infected or in the way of cup implantation. However, if there is a significant amount of bone loss, complex fractures may require extensive repair using revision total hip arthroplasty (THA) implants.