Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture

Abstract

Post-traumatic arthritis of the hip can develop in 12–57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed.

Keywords:

• acetabular
• arthroplasty
• fracture
• hip
• post-traumatic

Financial & competing interests disclosure

M Mont receives royalties from Stryker and Wright Medical Technology, Inc. He is a paid consultant for DJ Orthopaedics, Janssen, Joint Active Systems, Medical Compression Systems, Medtronic, Sage Products, Inc., Stryker, TissueGene and Wright Medical Technology, Inc. He receives research support from DJ Orthopaedics, Joint Active Systems, National Institute of Health (NIAMS & NICHD), Sage Products, Inc., Strker, TissueGene and Wright Medical Technology, Inc. Medical/Orthopaedic publications editorial/governing board are American Journal of Orthopedics, the Journal of Athroplasty, the Journal of Bone and Joint Surgery – American, the Journal of Knee Surgery, Orthopedics and Surgical Techniques International. He is also an appointed board member of AAOS. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Recent cementless designs show favorable functional outcomes and loosening rates.

• Complications of total hip arthroplasty (THA) for post-traumatic arthritis are the formation of heterotopic bone, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation.

• Heterotopic ossification prophylaxis with indomethacin or radiation may be considered in high-risk patients.

• Cemented acetabular components have higher rates of loosening and failure compared to cementless.

• Patients undergoing THA for post-traumatic arthritis have longer operation times, but no difference in blood loss.

• Those who undergo delayed THA for post-traumatic arthritis have a higher risk of sciatic nerve injury.