Late Total Hip Arthroplasty Following Failed Treatment Of An Acetabular Fracture

Objective To summarize the surgical technique and the clinical results of late total hip arthroplasty(LTHA)following failed operative or nonoperative treatment of an acetabular fracture.Methods From August1997 to May 2011,30patients(30 hips)were treated with uncementedLTHA after operative or nonoperative treatment of an acetabular fracture.There were 18 men and 12 women with an average age of 41 years(range,26-71years).The causes of the fractures included traffic accidents in 24 cases and falls in 6 cases.18 patients(18 hips)had previous open reduction and internal fixation(operative group)and 12 patients(12 hips)had been treated nonoperatively(non-operative group).The pre-operation diagnoses were posttraumatic arthritis in 21 hips,avascular necrosis of the femoral head in 9 hips.The time from fracture to LTHA was 4 months to 20 years.Implant design: uncemented ceramic-ceramic coupling prostheses were used in 18 hips(ceramic group).Uncemented metal-polyethylene coupling prostheses were used in 12 hips(metal-polyethylene group).ResultsNo operation was complicated by deep infection,dislocation,or nerve and blood vessel injury.Postoperative X-ray film showed that the coverage of the acetabular component and the initial fixation of the femoral components were excellent.There were 24 patients got follow-up,the mean follow-up was 8 years(range,5 to 19 years).Among them,18 patients had an excellent Harris hip score,4 patients had good and 2 patients had fair(because the sciatic nerve injury didn't get recovery).Until now,no patient was revised,or needed to be revised.Latest X-ray film showed that no acetabular or femoral component was loose for both metal-polyethylene group and ceramic group,Among metal-polyethylene group,linear wear of polyethylene insert was measured >2 mm/year in 8 cases,and their CT showed some zone have localized osteolysis.But no linear wear or osteolysis were found in the ceramic group.Conclusion 1? LTHA is an effective means of salvaging a hip following failed operative or nonoperative treatment of an acetabular fracture;2?The combination of uncemented LTHA and improved bearing surface may provide more satisfactory long-term clinical results.