Revision Rates for Acute Versus Delayed Total Hip Arthroplasty After Acetabular Fracture

Total hip arthroplasty (THA) has demonstrated utility in expediting return to function in the management of acetabular fractures. Despite its increased utilization, optimal timing to minimize complications and need for revision remains controversial and is often left to surgeon discretion. This study seeks to determine if timing, acute versus delayed (>30 days) THA for the management of acetabular fracture impacts rate and indications for revision arthroplasty.

Retrospective review identified 165 patients undergoing primary THA for an acetabular fracture at a Level I Academic Trauma Center from 1997 to 2020. Patients were stratified by performance of acute versus delayed (>30 days) THA. Charts were reviewed for rates and indications for revision arthroplasty. Statistical analyses were performed with α ≤ 0.05.

THA following acetabular fracture had an overall revision rate of 10.9 % (n=18), with an insignificantly increased rate associated with delayed THA (n=15, 13.0%) compared to acute THA (n=3, 6.0%). Prosthetic joint infection (PJI) was the most common indication for revision in delayed THA (n=9, 60.0%) and instability for acute THA (n=2, 66.7%). Patients undergoing acute THA had a higher rate of fracture dislocation (54.0% versus 25.2%, p=.0003) on presentation and increased mean age at time of injury (66.21 ± 10.38 vs 45.43 ± 15.41 years, p <0.0001) and arthroplasty (66.23 ± 10.8 vs 52.54 ± 12.73 years, p<0.0001).

THA timing following acetabular fracture remains equivocal with an insignificant difference in revision rate between acute and delayed THA. Level of Evidence: III.