Total Hip Arthroplasty After Acetabular Fracture

Objective:To investigate the characteristics of total hip arthroplasty after acetabular fracture,the changes of the anatomical structure of acetabular fractures and the reconstruction of the acetabular side.Method:17 patients with total hip arthroplasty who diagnosed as femoral head necrosis or traumatic arthritis after acetabular fracture and 17 patients with total hip arthroplasty who unilateral femoral head necrosis are selected from January 2012 to June 2016.Ptients with acetabular fractures are divided into the experimental group,another group as control group.We collect the statistics of the experimental group and the control group of patients with preoperative and postoperative Harris scores,the ranges of motion of hip joint,operation time,intraoperative bleeding volume,antibiotic duration and postoperative complications which contain dislocation,infection,loosening and heterotopic ossification after operation.We also collect the statistics of the two groups with relative leg-length,length of femoral offset,vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop.Result: The Harris score in the experimental group is increased from 37.1 preoperatively to 83.2 points and the Harris score in the control group is increased from 40.8 preoperatively to 86.4 points.Two groups of patients with hip joint range of motion in flexion,adduction,abduction,rotation has been significantly improved compared with preoperative.In the experimental group,the average operation time is 137 minutes,the average intraoperative bleeding volume is 941 ml,the average antibiotic application time is 3 days,the relative leg-length is about 15.8 mm after operation,the average femoral offset is 42.3 mm on the affected side and 43.2 mm on the other side,the vertical distance from hip rotation center to teardrop connection is 35.6 mm(healthy side is 35.1 mm)and the horizontal distance from hip rotation center to teardrop is 17.4 mm(healthy side is 18.0 mm).In the control group,the average operation time is 95 minutes,the average intraoperative bleeding volume is 294 ml,the average antibiotic application time is 2 days,the relative leg-length is about 6.5 mm after operation,the average femoral offset is 43.1 mm on the affected side and 42.7 mm on the other side,the vertical distance from hip rotation center to teardrop connection is 34.1 mm(healthy side is 34.8 mm)and the horizontal distance from hip rotation center to teardrop is 17.6 mm(healthy side is 17.8 mm).The Harris scores and ranges of motion of two groups after operations are improved.The operation time,intraoperative bleeding volume,antibiotic application time,postoperative complications in the control group are less than the experimental group.The relative leg-length of two groups is decreased and the anatomical hip center of two groups has been reconstructed.Conclusion:1.Total hip arthroplasty for the treatment of femoral head necrosis or traumatic arthritis after acetabular fractures has a good effect.2.The acetabular anatomical structure has changed after acetabular fractures and the recognition of the anatomical structure of the acetabulum is the core of the operation.3.The acetabular structural changes after acetabular fractures can not be reversed,and the good coverage and effective support of acetabular cup in total hip arthroplasty should be paid attention to.