Primary Total Hip Arthroplasty After Acetabular Fracture

After a displaced acetabular fracture, a patient may be predisposed to the development of symptomatic posttraumatic degenerative arthritis of the hip joint or avascular necrosis of the femoral head. In selected patients, a total hip arthroplasty may eventually be necessary irrespective of the method of initial management1-3. On the basis of a review of the results described by Letournel and Judet2 and Matta4 and on the basis of our experience, we determined that the likelihood that treatment will culminate in an arthroplasty is related to the initial type of fracture; the magnitude of the provocative force; the age and weight of the patient; and, when the initial management of the fracture was open reduction and internal fixation, the duration of the delay from the injury to the surgical procedure. When the initial acetabular deformity is relatively minor and when the acetabulum unites, especially following nonoperative treatment, a conventional arthroplasty is likely to lead to an uncomplicated recovery and a satisfactory outcome. Nevertheless, in selected cases, one or more complicating factors may be encountered. Following nonoperative treatment of an acetabular fracture, residual displacement may hamper a subsequent arthroplasty because of an occult or frank nonunion of the acetabulum or possibly because of a malunion or a malaligned nonunion5. When the initial management of an acetabular fracture was surgical, a belated arthroplasty performed to manage posttraumatic arthritis may be impeded by dense scar tissue, heterotopic bone, avascularity of the hip muscles or the acetabulum, obstructive hardware, or occult infection6. On the basis of a review of the few prior studies in the literature7-10, we found that the overall prognosis for a patient managed with a total hip arthroplasty after an acetabular fracture is less favorable than that for one managed with an arthroplasty performed because of primary degenerative arthritis. In the present study, we address the principal concerns regarding management with total hip arthroplasty after initial treatment of an acetabular fracture with closed or open reduction.