THA in patients with neglected acetabular fractures

Abstract

Introduction: Total hip arthroplasty (THA) outcomes in patients with neglected acetabular fractures are less favourable compared to THA for osteoarthritis or inflammatory arthritis. These poorer clinical outcomes are largely due to an unexpected bone deficiency, and the procedure is more time-consuming and complicated for cases that require acetabular reconstruction and bone grafting. The clinical outcomes of THA in neglected acetabular fractures are not often studied. Methods: This study is a retrospective single surgeon series of THA for 51 neglected acetabular fractures in 49 patients treated with THA alone, open reduction and internal fixation with THA, or acetabular defect reconstruction THA. Our series aims to focus on the surgical technique and describe the functional and radiological outcomes of neglected acetabular fractures treated with different THA approaches by a single surgeon. Results: Using the Harris Hip score at the mean long-term follow-up, there was a clear improvement in 90% of patients in the present study. The long-term results are encouraging in terms of clinical improvement, radiographic restoration of acetabular bone stock, and the centre of restoration. Discussion: The series shows that with proper planning and reconstruction using structural bone grafting techniques, a neglected fracture-dislocation with loss of structural support can be satisfactorily treated using primary components alone. Bony reconstruction and use of primary cementless components ensure long-term survival and preserve bone stock for an easier revision of THA, if necessary, in the future.

Keywords

• neglected acetabular fracture
• total hip replacement
• protusio
• impaction grafting