Failure Of Acetabular Component Research Articles

AAHKS Surgical Techniques & Technologies Award: Inferior Screw Fixation Decreases Acetabular Component Failure Following Revision Total Hip Arthroplasty

BackgroundAdjunctive screw fixation has been shown to be reliable in achieving acetabular component stability in revision total hip arthroplasty (THA). The purpose of this study was to assess the effect of inferior screw placement on acetabular component failure following revision THA. We hypothesized that inferior screw fixation would decrease acetabular failure rates. MethodsWe reviewed 250 patients who had Paprosky Type II or III defects who underwent acetabular revision between 2001 and 2021 across three institutions. Demographic factors, the number of screws, location of screw placement (superior versus inferior), use of augments and/or cup-cage constructs, Paprosky classification, and presence of discontinuity were documented. Multivariate regression was performed to identify the independent effect of inferior screw fixation on the primary outcome of aseptic rerevision of the acetabular component. ResultsAt a mean follow-up of 53.4 months (range, 12 to 261), 16 patients (6.4%) required re-revision for acetabular loosening. There were 140 patients (56.0%) who had inferior screw fixation, all of whom did not have neurovascular complications during screw placement. Patients who had inferior screws had a lower rate of acetabular rerevision than those who only had superior screw fixation (2.1 versus 11.8%, P = .0030). Multivariate regression demonstrates that inferior screw fixation decreased the likelihood of rerevision for acetabular loosening when compared to superior screw fixation alone (odds ratio: 0.1, confidence interval: 0.03 to 0.5; P = .0071). No other risk factors were identified. ConclusionsInferior screw fixation is a safe and reliable technique to reduce acetabular component failure following revision THA in cases of severe acetabular bone loss.

Acetabular Component Removal Systems

As primary total hip arthroplasty procedures continue to rise, acetabular revision surgery will be in increasing demand. Treatment of acetabular component failure and associated bone defects depends on patient characteristics, the degree and location of bone loss, the ability of the columns to support biologic fixation, and the presence of pelvic discontinuity. In revision total hip arthroplasty, technological advances have been made to address limitations of acetabular cup removal while preserving host bone stock. The goal of acetabular revision reconstruction should be to obtain stable fixation and restore the hip center. The various acetabular cup removal systems are discussed.

Protection of the Femoral Trunnion During Acetabular Revision Hip Surgery-A Novel Technique.

Revision of a failed acetabular component in the presence of an intact femoral prosthesis comprises approximately 20% of revision total hip replacements performed by the senior author. During this procedure, the femoral trunnion is at risk of damage because of scratching from retractors, reamers, or other instruments. Scratching can result in mechanically assisted crevice corrosion or adverse local-tissue reaction or trunnionosis leading to implant failure. We have used a variety of techniques for protection of the femoral taper over the last 30 years. We describe our current method of taper protection, using a cut segment of #5 silicon laryngeal airway, which is a simple and effective method.

Selective screw fixation is associated with early failure of primary acetabular components for aseptic loosening.

Selective supplementation of acetabular component fixation with a screw during primary total hip arthroplasty (THA) assumes that the surgeon can detect when an acetabular component needs additional stability. In contrast, nonselective screw users do not alter their practice based on their interpretation of stability and either use screws all or none of the time. We aimed to determine the effect of selective screw use on aseptic acetabular component loosening. We retrospectively reviewed aseptic failures of acetabular components after primaty THA. We compared the survivorship of selective and nonselective supplementation of acetabular fixation with respect to time to revision, obesity, and screw use. Selective screw use (n = 16) was associated with earlier acetabular component aseptic loosening (median: 1.9 years; interquartile range [IQR]: 1.1-5.0) compared to nonselective screw use (n = 22; median: 5.6 years; IQR: 2.0-15.3; P = .010). Selective screw use was independently associated with earlier revision after adjusting for patient obesity. Obesity was associated with selective screw use in 50% of the cases vs 14% of nonselective cases (odds ratio: 6.3; confidence interval: 1.2-25.2; P = .028), possibly reflecting the increased difficulty in achieving acetabular component stability in this and other settings with compromised bone. Surgeons should carefully assess component stability at time of primary THA. If the acetabulum is not stable, the addition of screws alone may not be sufficient for acetabular component stability.

Ten- to 16-Year Results of a Modern Cementless Dual-Mobility Acetabular Implant in Primary Total Hip Arthroplasty

BackgroundThe purpose of this study is to assess the radiographic results, clinical outcomes, and survivorship of a modern cementless dual-mobility cup (DMC) implant as a primary THA with a minimum of 10 years follow-up. MethodsThis study retrospectively assessed a series of 310 primary THAs using a modern-generation cementless DMC (Saturne acetabular cup) between April 2001 and December 2005 at a single center. Patients were followed prospectively clinically and radiographically after surgery. Hips with follow-up less than 120 months were excluded from the study (5 lost to follow-up and 167 deceased). In total, a cohort of 138 hips were included for preoperative and postoperative analysis with an average follow-up of 152.4 months. All complications were collected, and a Kaplan-Meier survival analysis was performed. ResultsThere was a significant increase in the mean Harris and Postel-Merle d’Aubigne scores between preoperative and postoperative cohorts (P < .001). No loosening of the cup and no acetabular osteolysis were found at final follow-up. No prosthetic dislocation, no intraprosthetic dislocation, and no infections were reported. The survival curve of THA in the total cohort (N = 310) was about 98% at 10 years with 3 stem revisions for femoral fracture. One psoas impingement was also described. ConclusionThis study showed no acetabular component failure and no reported cases of acetabular osteolysis with this DMC acetabular component retention at 10 years. No prosthetic or intraprosthetic dislocation was reported.

Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review.

Acetabular revision especially in the presence of severe bone loss is challenging. There is a paucity of literature critiquing contemporary techniques of revision acetabular reconstruction and their outcomes. The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal shells, uncemented revision jumbo shells, reinforced cages and rings, oblong shells and custom-made triflange constructs). Full-text papers and those with an abstract in English published from January 2001 to January 2016 were identified through international databases. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. Overall, patients had improved outcomes irrespective of the technique of reconstruction as documented by postoperative hip scores. Our pooled analysis suggests that oblong cups components had a lower failure rate compared with other different materials considered in this review. Custom-made triflange cups had one of highest failure rates. However, this may reflect the complexity of revisions and severity of bone loss. The most common postoperative complication reported in all groups was dislocation. This review confirms successful acetabular reconstructions using diverse techniques depending on the type of bone loss and highlights key features and outcomes of different techniques. In particular, oblong cups and tantalum shells have successful survivorship.

Resection arthroplasty in radiation-induced osteonecrosis of the hip

PurposeThe purpose of this study was to evaluate the choice of appropriate surgical procedure through follow-up of postoperative results in patients with radiation-induced osteonecrosis of the hip. Materials and methodsFrom January 1990 to December 2010, 25 patients underwent surgery for hip osteonecrosis after pelvic irradiation, for a total of 31 cases. The mean patient age was 61.6 years and the mean follow-up period was 60.4 months. There were 28 cases of primary total hip arthroplasty, three cases of primary resection arthroplasty, and six cases of secondary resection arthroplasty after total hip arthroplasty failure. The THA group was classified into two groups according to the period of operation: 1990 ∼ 2000 and 2001 ∼ 2010. THA and resection arthroplasty were compared retrospectively. ResultsIn the 16 cases of primary total hip arthroplasty (1990 ∼ 2000), 8 cases (50%) had a failed acetabular component. In 12 cases of primary total hip arthroplasty (2001 ∼ 2010), two cases (16.7%) had a failed acetabular component and two cases (16.7%) had an infection. Six cases underwent resection arthroplasty after total hip arthroplasty. There were no complications in the nine cases of resection arthroplasty. Seven of the nine cases (77.7%) had pain relief. The mean VAS scores of the resection arthroplasty group were lower than those of the total hip arthroplasty group at the time of the latest follow up (P = 0.04). ConclusionsThe failure rate of total hip arthroplasty used in radiation necrosis has decreased. Therefore, total hip arthroplasty should be the primary surgical method in patients with radiation-induced osteonecrosis of the hip. Resection arthroplasty is limited as first-line therapy due to functional problems. It use should be limited to pain control in low-demand elderly patients.

An acetabular-preserving procedure for pelvic giant cell tumor involving partial acetabulum

BackgroundThe management of pelvic giant cell tumors (GCTs) involving the acetabulum remains a challenge for surgeons on how to balance the relative benefits of minimizing recurrence and maintaining postoperative hip function. The present study was to present and evaluate the clinical indications, operative technique, and outcomes of pelvic GCTs involving partial acetabulum treated with multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless total hip arthroplasty (THA).MethodsWe retrospectively reviewed seven patients with pelvic GCTs involving partial acetabulum who underwent multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA from January 2010 to October 2014. We assess the outcome including the bone graft healing, nonunion, hardware failure, infection, tumor recurrence, and metastasis. And the functional outcome was evaluated by the Musculoskeletal Tumor Society (MSTS)93 score.ResultsAll patients were followed up for a mean of 38.1 months (range 26–61 months). All bone grafts are union. No failure of acetabular components, wound healing problem, or deep infection was suspected. No patient experienced metastasis. Recurrence was observed in one out of seven patients, treated by extended resection and implanting iodine ions in the surgical area. The mean MSTS93 score was 29.4 (range 28–30). All patients were disease-free and resumed activities of daily living at the most recent follow-up.ConclusionsAs long as one of the two columns is retained and the resulting defect does not exceed the supra-acetabular line, multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA is a viable strategy for the treatment of pelvic GCTs involving partial acetabulum. However, a large-scale prospective clinical study is still needed to verify these procedures.

Porous tantalum uncemented acetabular components in revision total hip arthroplasty: a minimum ten-year clinical, radiological and quality of life outcome study.

Reconstruction of the acetabulum after failed total hip arthroplasty (THA) can be a surgical challenge in the presence of severe bone loss. We report the long-term survival of a porous tantalum revision acetabular component, its radiological appearance and quality of life outcomes. We reviewed the results of 46 patients who had undergone revision of a failed acetabular component with a Paprosky II or III bone defect and reconstruction with a hemispherical, tantalum acetabular component, supplementary screws and a cemented polyethylene liner. After a minimum follow-up of ten years (ten to 12), the survivorship of the porous tantalum acetabular component was 96%, with further revision of the acetabular component as the end point. The ten-year survivorship, with hip revision for any reason as the end point, was 92%. We noted excellent pain relief (mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score pain 92.6, (40 to 100)) and good functional outcomes (mean WOMAC function 90.3 (30.9 to 100), mean University of California Los Angeles activity scale 5 (2 to 10)) and generic quality of life measures (mean Short Form-12 (SF-12) physical component 48.3 (18.1 to 56.8), mean SF-12 mental component 56.7 (32.9 to 70.3)). Patient satisfaction with pain relief, function and return to recreational activities were excellent. Uncemented acetabular reconstruction using a tantalum acetabular component gives excellent clinical and quality of life outcomes at a minimum follow-up of ten years. Cite this article: Bone Joint J 2016;98-B:767-71.

Acetabular re-revision with impaction bone grafting and a cemented polyethylene cup; a biological option for successive reconstructions.

For the revision of failed acetabular components impaction bone grafting (IBG) with a cemented cup is a well known technique. Claims have been made that this is a biological reconstruction technique, restoring the bone stock loss and thereby facilitating future revisions. However, there are no scientific data proving this claim. In this study, we present the clinical and radiographic outcome of 11 consecutive acetabular re-revisions in 10 patients with again IBG and a cemented polyethylene cup observed in a previously reported cohort of 62 acetabular IBG revisions. All data were prospectively collected. Kaplan-Meier survivorship analysis was performed. The mean follow-up after re-revision was 10 years (5-15) and 28 years (26-30) after the primary revision. No patients were lost to follow-up. The mean HHS improved from 37 (12-49) points to 71 (40-95) points at final follow-up. Survival with further cup revision for any reason as endpoint was 91% (95% confidence interval (CI) 51 to 99) at 10 years. When excluding one early cup re-revision for malpositioning 3 weeks postoperative, survivorship with further cup revision for aseptic loosening as endpoint was 100% (95% CI 37-100) at 10 years. Survival with further cup re-operation for any reason as endpoint was 82% (95% one-sided CI 45-95). In all surviving re-revisions trabecular incorporation was observed without radiolucent lines. This study shows that, due to restoring the bone stock, even successive acetabular reconstructions using IBG and a cemented cup are possible with satisfying 10 years survivorship.

Total Hip Replacement: Tensile Stress in Bone Cement is influenced by Cement Mantle Thickness, Acetabular Size, Bone Quality, and Body Mass Index

Background: High stress developed in the cement mantle of a total hip replacement is reported to contribute to premature failure of acetabular components. We postulate that stress level is influenced by cement mantle thickness, acetabular size, bone quality and body mass index. Methods: Finite element models of reconstructed hemi pelves of different sizes and acetabular diameters (46, 52 and 58 mm) were created from CT-Scan data. We investigated the effects of cement mantle thickness (1, 2, 3 and 4 mm), acetabular size, body mass index (BMI = 20, 25 and 30 kg/m2) and bone quality on stress level developed in the cement mantle. Findings: Peak tensile stresses in the cement mantle increased with a decrease in cement mantle thickness, acetabular size and bone quality and an increase in BMI. Interpretation: Our results indicate that a 4-mm-thick cement mantle is required in small reconstructed acetabulae of ≤ 50-mm diameters, while a 1-mm thick cement mantle can be used on larger reconstructed acetabulae of ≥ 58 mm diameter. Patients with poor bone quality require at least a 4-mm-thick cement mantle to reduce the risk failure caused by high stress level in the cement mantle.

Should We Worry About Periacetabular Interference Gaps in Hip Resurfacing?

Press-fit acetabular component seating in hip resurfacing can be challenging as a strong interference fit is required. It has not been established whether reducing the acetabular underream minimizes incomplete component seating or leads to increased acetabular loosening. We examined (1) the incidence and natural history of postoperative interference gaps in hip resurfacing and (2) whether reduction of the acetabular underream from 2mm to 1mm reduces the incidence of periacetabular interference gaps. Of 327 Birmingham Hip™ Resurfacings (Smith & Nephew Inc, Memphis, TN, USA) performed by a single surgeon from 2005 to 2010, we evaluated 306 hips with a minimum 1-year radiographic followup. Postoperative periacetabular interference gaps were monitored for radiographic gap resolution at latest followup. The frequency of incomplete component seating was compared between acetabula prepared with 1- and 2-mm underream techniques. Minimum followup was 1year (mean, 2.7years; range, 1-6years). Fifty-one percent of the postoperative radiographs demonstrated the presence of a periacetabular interference gap. At latest followup, 96% of these gaps were no longer visible. We observed a reduction in the number of interference gaps identified when acetabular preparation changed from a 2-mm underream (63%) to a 1-mm underream (39%). There were no revisions due to acetabular failure. Periacetabular interference gaps were common in this series but not associated with acetabular component failure. The use of a 1-mm underream is sufficient for adequate short-term press-fit fixation of the acetabular component in Birmingham Hip™ Resurfacing arthroplasty. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Bilateral Catastrophic Acetabular Component Failure after Ceramic-on-Polyethylene Total Hip Arthroplasty -A Case Report-

Copyright c 2012 by Korean Hip Society 148 A ceramic femoral head articulating with a polyethylene (PE) liner is one of the bearing surface options available for total hip arthroplasty (THA). The wear rates of acetabular PE in ceramic-on-PE articulations have been reported in hip simulation and clinical studies to be lower than those of metal-on-PE implants. Although, femoral metal heads have been associated with complete wear-through of the PE liner and metal shell, extensive wear resulting in the penetration of a femoral head through an acetabular cup is rare for ceramic-on-PE THA. Nevertheless, several reports have been issued on the complete or even the catastrophic PE failure of ceramic-on-PE systems. However, no report has yet described catastrophic bilateral PE failure after ceramic-on-PE THA. Here, we present a case of bilateral complete PE wear with acetabular cup perforation after ceramic-on-PE THA. The patient was informed that case data would be submitted for publication, and provided consent.

A well-fixed femoral stem facing a failed acetabular component: To exchange or not? A 5- to 15-year follow-up study

There is no consensus about the necessity of exchanging a stable femoral component during revision total hip arthroplasty (RTHA) when only the acetabular component requires replacement. Sparing the femoral component reduces morbidity, but can make acetabular replacement technically more difficult. Moreover, the outcome of the retained femoral component is also a question, especially with older implants. Isolated acetabular component RTHA results in lower surgical morbidity, and does not increase the risk of later femoral complications. Eighty-nine patients, mean age 68, underwent surgery (anterior approach on traction table) for isolated acetabular component revision between 1994 and 2005. The femoral component had been implanted a mean 10.5 years before revision. Fifteen patients died, mean age 84.5. Eleven patients, mean age 81.3, were lost to follow-up and four underwent revision due to a subsequent infection (range 14 months - 11 years). Fifty-nine patients were evaluated after a mean 8.6 years (range 4 - 15 years). At follow-up the mean Harris score was 89.2 [IC=6.89; 44 - 100] and the mean Merle d'Aubigné score was 15.3 [IC=1.57; 11 - 18]. Five patients (5.6%) underwent surgery again due to postoperative dislocation. Six patients underwent surgery for recurrent acetabular loosening due to allograft resorption. The size of the bone defects did not increase the risk of these failures (P>0.6). Fractures occurred in two femoral components 6 and 9 years after revision. Polyethylene wear occurred in three patients requiring two repeat revisions at 6 and 7 years. In both cases the femoral component included a titanium head, which caused the wear. Implant survival at 8.6 years was 85.16 ± 0.117% all causes of revision combined, 88.47 ± 0.113% if infectious causes were excluded and 93.6 ± 0.07% if only cases of acetabular component failure were taken into account. Intermediate term outcomes are satisfactory if stable femoral components are retained. Nevertheless, this procedure should be performed in situations of correctly oriented modular components. In single piece (monoblock) femoral implants, or in implants with a history of failure, this technique should be restricted to elderly and/or fragile patients. Level IV, Retrospective study.

Chronic Renal Failure and Catastrophic Failure of an Acetabular Component

Polyethylene wear and particulate-induced complications affect the survival of primary and revision total hip prostheses. Polyethylene failure can present as a fracture of the acetabular liner, massive liner wear with or without osteolysis-associated complications, or a combination of the two. Various degrees of metallosis can be seen in cases of catastrophic polyethylene failure. If the polyethylene wear or failure is not surgically addressed in a timely fashion, not only can the acetabular cup loosen, but massive wear of the acetabular metal shell may ensue with possible destruction of the component's locking mechanism. We present a case of a patient with catastrophic polyethylene failure and wear-through of the titanium acetabular component, resulting in severe periacetabular metallosis. Preoperatively, the patient was known to have chronic renal insufficiency thought to be secondary to hypertension. After removal of the metal-ion generator by revision of the acetabular cup, the renal insufficiency markedly improved. We are not aware of any other articles describing renal failure in the setting of metallosis secondary to total hip arthroplasty failure and its improvement with revision of the total hip arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-year-old male automobile mechanic, who had undergone a right total hip arthroplasty seventeen years earlier, presented with a squeaking noise from the right hip and pain of one year's duration. Prior to this presentation, he had been lost to follow-up for approximately ten years after the arthroplasty. The patient's medical history was notable for colon cancer and hypertension. On physical examination, there was obvious noise and crepitus during hip motion, and the patient had an antalgic gait. The Harris hip score was 43 points. Radiographs (Fig. 1) showed catastrophic wear of the femoral head through the acetabular cup with fracture of the …

An Analysis of Stably Fixed Femoral Components Retained During Revision Total Hip Arthroplasty

This study was conducted to analyze the clinical and radiographic results of isolated acetabular revisions during which intact femoral stems were retained. Twenty-nine hips of 26 patients who were followed up for a minimum of 3 years were examined. The average time from primary operation to revision surgery was 9.2 years, and the average follow-up time after revision was 5 years. The average Harris hip scores improved from 56.4 to 89.8 points after revision surgery, and in all cases, the acetabular components and femoral stems were assessed as stable at the final follow-up. The average length of service of the femoral components was 14.2 years. In conclusion, we recommend that isolated acetabular revision be considered in cases with an acetabular component failure and a stable femoral component.

Hybrid Assembly of Metal Head and Femoral Stem From Different Manufacturers During Isolated Acetabular Revision

During revision of a failed acetabular component with well-fixed antiquated femoral stem, the same variant of metal head is usually not available in the inventory production. We gathered the stems retrieved from revision surgeries and tried to reassemble with the commercially available femoral heads. This study reports the results of suitable hybrid assembly of metal heads with the most common antiquated femoral stems from different manufacturers. Three hybrid combinations were determined and pull-off strengths of these hybrid combinations were performed through in vitro studies to evaluate the quality of the taper locks.

Cup loosening after cemented Metasul® total hip replacement: a retrieval analysis

Small-diameter cemented Metasul® cups have been previously identified to be at high risk of early loosening. We asked whether this particular mode of failure was associated with a specific histological feature. Periprosthetic tissues were obtained at the time of revision of two aseptically loose cemented Metasul® cups. Each tissue sample was processed for routine histological analysis. A slight metallosis was visible microscopically in all tissue samples. Metallic wear-debris particles were present both extracellularly and within the cytoplasm of macrophages. We noted a perivascular infiltration of lymphocytes accompanied by mature plasma cells. Our observations are compatible with the hypersensitivity-like reaction previously reported, described as an aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Although wear was within normal reported range limits, this tissue reaction appeared as a consequence of continuous release of metallic ions from the prosthetic articulation. We hypothesise that ALVAL was involved in acetabular component failure, although acetabular loosening may have been initiated by high mechanical stress.

Long-Term Survival and Reason for Revision of Wagner Resurfacing Hip Arthroplasty

The long-term survival of 270 Wagner resurfacing hip arthroplasties was determined. Two patients were lost to follow-up. Eleven hips remained unrevised at 15 to 22 years. Survival at 5, 10, and 16 years was 74%, 35%, and 17%, respectively. Survival in patients older than 55 years was better after 5 years than that for patients 55 years or younger ( P = .0067). Femoral neck fracture occurred in 2% of the total cohort. Femoral component failure was an early and midterm complication. Acetabular component loosening was the most common reason for revision. The proportion of cases revised for acetabular component failure increased with time. These long-term data in this large series provide important historical results against which the relative benefits of contemporary designs may be evaluated.

Open Reduction Internal Fixation and Primary Total Hip Arthroplasty of Selected Acetabular Fractures

The purpose of our study was to analyze the outcomes of patients treated with combined open reduction internal fixation (ORIF) and primary total hip arthroplasty (THA) for selected cases of acetabular fractures. Retrospective case series. University Medical Center. Four hundred twenty patients underwent ORIF for displaced acetabular fractures at our institution. Twenty-one of these patients underwent ORIF and primary THA. All surgeries were performed under the direct supervision of a fellowship-trained orthopaedic trauma surgeon and a fellowship trained adult reconstructive surgeon who acted as a cosurgeon. At the time of review, 18 patients met the 1-year follow-up requirement and formed the study cohort. Mean patient age was 71 years (range 55-86 years). There was 1 transverse fracture, 1 anterior column posterior hemitransverse and 1 both-column fracture. There were 15 posterior wall fractures. Of the 15 posterior wall fractures, 1 was associated with posterior column fracture, 1 with dome fracture, 2 with transverse fractures, and 9 with femoral head impaction fracture. There were 2 patients with isolated posterior wall fractures. Clinical outcomes were analyzed using Harris hip score. Radiographs were analyzed for implant migration and loosening around the implant. Of the 18 patients in the study, 14 patients were followed for more than 2 years (average 3.9 years, range 1-10.1 years). All but 1 patient healed successfully. One patient required revision and placement of a constrained prosthesis due to failure of acetabular component, 3 weeks post-index procedure. Harris hip score ranged from 78 to 99 with a mean of 88. The radiographs showed an average medial displacement of 1.2 mm (range 0-3 mm) and an average vertical displacement of 1.3 mm (range 0-4 mm). There was no radiographic evidence of acetabular component loosening, but loosening was evident on 1 uncemented femoral stem. Treatment of acetabular fractures remains challenging particularly in the presence of severe osteopenia, comminution, or associated femoral head fracture. In appropriately selected patients, ORIF and primary THA provide an acceptable treatment option.