Abstract
Introduction
The incidence of acetabular fractures in the elderly population is increasing. Treatment with staged or acute total hip arthroplasty (THA) is occasionally required. The role of acute THA however, remains controversial. The purpose of our study was to assess the outcomes of a subgroup of elderly patients who underwent early simultaneous open reduction and internal fixation (ORIF) and primary THA for displaced acetabular fractures.
Materials and Methods
86 patients underwent ORIF for displaced acetabular fractures at The Alfred Hospital, Melbourne between August 2007 and August 2009. Eight of these patients underwent early simultaneous ORIF and primary THA. Mean age was 79 years. Mean time between injury and surgery was 4 days. Mean time of follow-up was 19 months. There were 3 both-column fractures, 2 anterior column, 1 posterior wall, 1 transverse with posterior wall and 1 T-shaped. Two patients had an associated neck of femur fracture and two had an impaction fracture of the femoral head. The Harris and Oxford hip scores were used to assess clinical outcome. Radiographs were analysed for component loosening.
Results
There was one unrelated post-operative death at 5 months. There was a high rate of post-operative complications. Four patients developed heterotopic ossification, 2 extensive. There was one superficial and one deep infection. One patient has a persistent post-operative foot drop. The Harris hip scores ranged from 45 to 86 with a mean of 68. The Oxford hip scores ranged from 24 to 37 with a mean of 32. There was no evidence of acetabular component loosening.
Conclusion
Acute THA for displaced acetabular fractures in the elderly is associated with significant post-operative complications and relatively poor clinical outcomes. However, we believe there may be an indication for this treatment when there is an associated ipsilateral fracture of the femoral neck or femoral head.
