Early Conversion Total Hip Arthroplasty for High-Energy Acetabular Fractures Is Associated With Poor Outcomes

Conversion total hip arthroplasty (THA) is performed as a salvage operation for patients who develop symptomatic posttraumatic arthritis following open reduction internal fixation (ORIF) of displaced acetabular fractures. Historically, high failure rates in this patient population were related to acetabular loosening. Recent studies, however, have demonstrated improved outcomes with modern techniques. This study aims to evaluate the outcomes and survivorship of early conversion THA after high-energy acetabular fractures at our institution.

A retrospective review was performed of all patients who underwent acetabular ORIF and subsequent conversion THA at a Level I trauma center between 2002 and 2022. Patients with less than 1 year follow-up after conversion THA without complication were excluded. Patient demographics, injury characteristics, perioperative details of ORIF and THA, complications, and subsequent reoperations and revisions were recorded.

A total of 144 cases were included. The average age was 51.3 years at the time of ORIF with transverse posterior wall (46.5%) and posterior wall (30.6%) fracture patterns predominating. The median time from ORIF to conversion THA was 1.1 years (interquartile range [IQR], 0.7-1.8). Complications occurred in 47 THAs (32.6%), with dislocation (n = 19, 13.2%) and periprosthetic joint infection (n = 17, 11.8%) being the most common. The reoperation and revision rate following conversion THA was 21.5% and 18.1%, respectively. The median time from conversion THA to revision THA was 0.5 years (IQR, 0.1-1.3), with 69.2% of revisions occurring within the first year.

Early conversion THA following acetabular ORIF in our cohort was associated with a marked rate of complication and revision surgery. Although aseptic loosening was less prevalent, instability and infection rates were significant concerns. These findings underscore the need for continued improvements in managing this challenging patient population.

Level III. See Instructions for Authors for a complete description of levels of evidence.