Combined cementless acetabular reconstruction with bone grafting in total hip replacement after acetabular fractures treated nonoperatively

Abstract

BackgroundAcetabular fractures are serious and challenging orthopedic injuries. Many of these fractures may potentially result in late complications that can occur with or without initial surgical treatment. Such complications usually end in post-traumatic arthritis. Once symptomatic post-traumatic arthritis has developed, options for salvage are generally limited to total hip arthroplasty (THA) and arthrodesis. Whether initial nonoperative or operative treatment was used to manage acute and highly displaced acetabular fractures, formidable problems such as nonunion, malunion, bone defect, and heterotopic bone may complicate the arthroplasty. More recent studies have evaluated the techniques of THA after an acetabular fracture initially managed by a nonoperative or an operative course. Various reconstructive strategies have been assessed in an attempt to advice improvements in the surgical protocol.AimThe aim of the work was to evaluate the early results of THA using cementless acetabular components combined with bone grafting in the reconstruction of the hip joint in patients with post-traumatic arthritis after an old nonoperatively treated acetabular fracture or fracture dislocation.Patients and methodsThis prospective study included 12 patients who had end-stage arthritis. All patients had old acetabular fractures either with or without hip dislocation. All patients had a nonoperative treatment for their fractures 1-5 years before presentation for total hip replacement. Clinical, laboratory, and radiological evaluations before surgery were performed. In all patients, conventional cementless cups combined with bone graft from their own femoral heads were used to fill defects and reconstruct the acetabulum. The duration of the follow-up period ranged from 1 to 3 years.ResultsClinically, there was marked improvement in the Harris Hip Score (satisfactory results in 83.33% of the study group at the last follow-up) with special concern to postoperative pain relief, the range of hip movement, and the walking distance. Radiologically, all cups were placed in the normal hip center with no early signs of cup loosening, migration, or position change with good integration of the bone graft.ConclusionThe results were very satisfactory and significantly in favor of using this technique using conventional cementless cups combined with autogenous bone grafting to reconstruct the acetabulum in certain cases of old united fractures of the acetabulum saving the extra costs of metallic augments, special cups, or modular reconstructions using cages or rings and achieving a superior biological and biomechanical reconstruction.