Abstract
A series of sixteen patients, 14 males and 2 females with an average age of 50 years (28–93) underwent total hip replacement surgery after acetabular fracture. Thirteen patients had previously undergone internal fixation of their acute fractures. Hip replacement surgery was performed by a single surgeon over an eight year period at an average of 30.36 (range 3–84) months after injury. Cases include high energy injuries as well as low energy fractures of the elderly (2 patients).
These were complex procedures due in some cases to the dramatic femoral head and acetabular bone stock loss when avascular necrosis had occurred following internal fixation. The use of acetabular mesh, allograft and reinforcement rings is discussed.
At the time of reporting the total hip replacements in this group of relatively young patients continue to be highly successful. One hip has been revised for recurrent dislocation.
This paper describes important surgical tips for the management of these complex cases. Removal of exposed metal work can be difficult. A role for MRI scanning in the early postoperative care following fracture fixation is postulated. The importance of early liaison of fracture fixation surgeons with arthroplasty colleagues leads to earlier surgery with reduction of bone stock loss.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
