Management of Acetabular Fractures by Prosthetic Hip Replacement

Total hip arthroplasty (THA) in the setting of an acetabular fracture remains a difficult reconstructive dilemma. The procedure is much more difficult than a regular THA for degenerative arthritis especially on the acetabular side mainly due to the presence of bone defects, nonunions and may be obstructive hardware and HO. We Aim to: 1Express these difficulties and the methods used to overcome them, 2Report on the early results of these cases regarding the functional outcome, complications and revision surgeries, and 3Correlate these outcomes with the different variables including the age, previous treatment and method of fixation of the acetabular component. Patients and Methods: From this view the procedure may resemble a revision surgery and should be dealt with as one. Results: 44 patients 30 males and 14 females were operated upon with mean age 50.8 years. They were divided into ORIF group (17 cases), non-ORIF group (11 cases) and early THA group (16 cases). We had defects in 41 cases (more in nonORIF than ORIF group) ranging between cavitary deficiencies in 11 cases, segmental in 10 cases, combined in 12 cases and pelvic discontinuity in 8 cases. Autologous femoral head bone graft was used in 38 cases. Impaction allografts were used to fill defects in 3 cases. Augmentation devices were used in 6 cases; a rim mesh in 4 cases, a floor mesh in 1 case and a Müller ring in 1 case. Other methods used included a high hip center in 1 case and reduction and fixation of the fracture in 9 cases. Moreover, nonunions were more common among the non-ORIF group. Other pre-operative complications included partial sciatic nerve injury in 5 cases, HO in 10 cases and obstructive hardware in 11 cases which mandated its removal. The average post-operative Harris hip score was 83.4 (range 35-95) at the latest follow-up. 33 (75%) patients had good or excellent Harris hip scores at their latest followup, 4 (9. 1 %) had fair scores, and 3 (6.8%) had poor scores. Conclusion: Our results were comparable to the recently published series; however they are still inferior to the results of THA done for degenerative arthritis.