The role of total hip arthroplasty in acetabular fracture management

Abstract

Total hip arthroplasty has a useful adjunctive role in at least three different situations in the management of an acetabular fracture. Traditionally, total hip replacement is the principal method of management of an acetabular fracture that is managed nonoperatively or by resorting to an open reduction and internal fixation and progresses to severe posttraumatic arthritis. When a conservatively managed acetabular fracture progresses to a nonunion/malunion, the method of choice is a total hip arthroplasty combined with restoration of the integrity and/or possible realignment of the pelvic ring. More recently, immediate total hip arthroplasty of certain displaced acetabular fractures that have poor prognoses, whether a traditional operative or nonoperative course is followed, has become an attractive therapeutic option. A multiscrew porous-coated cementless acetabular component is ideally suited for fixation of the acetabulum and effectively serves as a “hemispherical plate”. Our indications for immediate total hip arthroplasty include patients who have two or more of the following risk factors: advanced age, serious medical conditions, including obesity, osteopenia, delayed presentation and certain high-risk fracture types, especially in the presence of extensive abrasion, impaction or fracture of the femoral head, and/or acetabulum. In this article, we review the unique features regarding indications, preoperative assessment, planning, and surgical considerations for these clinical problems.