Total Hip Replacement Following Unsuccessful Acetabular Repair: A Case Report

Traumatic avascular necrosis (AVN) of the femoral head is a major issue after acetabular fractures, affecting 20-40% of cases even with precise joint realignment. Performing total hip replacement (THR) as a salvage procedure introduces specific surgical obstacles absent in standard primary THR.

This report covers a 26-year-old man injured in a motor vehicle collision with an acetabular fracture. After open reduction and internal fixation (ORIF), he had femoral head AVN with superior migration and absorption of superolateral acetabular rim at 18 months, requiring THR. Using a posterior surgical approach to hip, THR was performed by extracting unstable screws and placing cementless acetabular and femoral components. He had an unremarkable recovery, with notable improvements in pain and mobility.

Salvage THR after acetabular ORIF requires expertise, but thorough pre-operative strategy, targeted implants, and effective hardware removal deliver reliable success. Young adults with both-column injuries need ongoing AVN monitoring, regardless of initial perfect alignment.