Early Total Hip Arthroplasty for the Treatment of Acetabular Fractures

Abstract

AbstractEarly total hip arthroplasty in patients with acetabular fractures is considered in rare situations with specific indications. Generally, this treatment option is considered in patients older than 55 or 60 years, but the physiological age must also be considered. The patient should be functional and ambulatory before the injury and healthy enough to tolerate the insult of a surgical procedure of this magnitude. Preexisting conditions such as osteoporosis and osteoarthritis encourage consideration of total hip arthroplasty. Specific injury patterns are predictive of fixation failure in older patients with acetabular fractures. These findings represent worse articular injury and low bone density that would intuitively lead to failure. This “gull sign” or “seagull sign” describes either the central–superior dome impaction seen in high-transverse fractures or the impaction of the subchondral bone on the intact edge of a partial posterior column fracture. Other radiographic predictors of failure in posterior wall fractures include comminution of more than three fragments, involvement of the superior dome in high posterior wall fractures, and marginal impaction. Older patients have a high incidence of these radiographic findings, predictive of fixation failure without arthroplasty. Other injury characteristics including concomitant displaced femoral neck fracture and femoral head injury are also indications for total hip arthroplasty in older patients. Acute hip arthroplasty can be performed using the posterolateral, direct lateral, anterolateral, and anterior approaches to the hip. There are also reports of patients who underwent combined approaches to the hip for stabilization of the injury using the anterior intrapelvic approach and ilioinguinal approach. Combined approaches are generally not recommended. Extended approaches are not recommended or necessary for early arthroplasty in acetabular fractures. This review article highlights recent trends of early total hip arthroplasty in senior patients with acetabular fracture, and the indications for the procedure, complications, clinical outcomes, and technical considerations, with cases to highlight these concepts.