Total Hip Replacement after Acetabular Fracture Fixation: Surgical Challenges, Techniques, and Outcomes

Post-traumatic arthritis following acetabular fracture fixation is the most common cause of chronic hip pain and disability. Following an acetabular fracture, there is a high chance of secondary osteoarthritis; thus, the total hip replacement (THR) serves as a reliable procedure. However, doing THR after prior open reduction and internal fixation (ORIF) of the acetabulum is technically challenging due to scarring, distorted anatomy, implant in situ, and scanty bone stock. The study aims to assess the surgical difficulties, complications, and functional results in patients undergoing THR after acetabular fracture fixation.

It is a retrospective study conducted in Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India between January 2018 and December 2023. Thirty-one patients who had prior acetabular fixation and subsequently underwent THR were included. The demographics data, fracture pattern, surgical approach, implant type, and complications were recorded. Functional outcomes were assessed by using the Harris Hip Score (HHS) pre-operatively and following subsequent follow-up. Radiological evaluations were done to assess the component alignment, bone graft incorporation, and to determine if any signs of loosening.

The mean age was 52.3 years (range: 38-72), with 21 males and 10 females. The mean follow-up was 18 months. The mean pre-operative HHS improved from 48 to 85 (P < 0.001). However, the major intraoperative difficulties included the previous implant, that is, acetabular plates or screw removal (30%), poor bone stock (20%), and difficult component positioning (26.7%). However, there were minimal complications. One patient had transient sciatic neuropraxia. There were no deep-seated infections, dislocations, or early loosening of implants reported. Both the cemented (11 cases) and uncemented (20 cases) THR provided satisfactory fixation.

THR after the acetabular fracture fixation is technically complex but gives excellent results when performed with meticulous surgical planning and proper implant selection. The cemented THR is done in old patients having osteoporotic bone, while uncemented components are done in younger patients, which gives long-term stability.