Total Hip Arthroplasty for Untreated Acetabular Fractures: A Case Series

Acetabular fractures are managed acutely with internal fixation but when left untreated for more than 3 weeks, these injuries lead to post-traumatic arthritis and osteonecrosis of the hip. Such complications indicate the need for total hip arthroplasty. In the Philippines, no studies have been published documenting the outcomes of managing untreated acetabular fractures with total hip arthroplasty.

This study documented five cases of untreated acetabular fractures managed with total hip arthroplasty in Vicente Sotto Memorial Medical Center, Philippines in 2023. The cases included four males and one female ages 21-46 years old. All cases resulted from motorcycle crashes and most presented with untreated posterior wall fractures with posterosuperior, segmental, acetabular defects, and chronic posterior hip dislocations. The chronicity of the fractures ranged from 17 to 32.5 weeks. The cases were managed with acetabular augments when needed, dual mobility cups, and femoral short stems. In the short-term postoperative period, all cases had improved Forgotten Joint Scores and Harris Hip Scores with no incidence of infection, dislocation, or implant failure.

Untreated acetabular fractures managed with total hip arthroplasty prevent post-traumatic arthritis and osteonecrosis of the hip. Segmental acetabular defects and chronic hip dislocations present in these cases can be managed with acetabular augments and dual mobility cups. When these injuries present in the young, femoral short stems can be used to preserve the femoral neck and maximize the proximal metaphyseal bone stock.