Aims. Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods. We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d’Aubigné score and Matta’s radiological grading at one year and at latest follow-up. Results. Immediate postoperative radiological Matta’s reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d’Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta’s radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d’Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta’s radiological grading at latest follow-up also remained unchanged. Conclusion. Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window. Cite this article: Bone Jt Open 2024;5(2):147–153

Aims. Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Methods. Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected. Results. Our series included 20 patients, with a mean age of 77 years (46 to 90). All the patients had at least one comorbid condition. Radiographs showed that 75% of the fractures were pure transverse fractures, and a transverse component was present in 90% of patients. All our patients underwent surgical treatment: open reduction and internal fixation, revision of the acetabular component, or both. Mean follow-up was 24 months, and HHS at last follow-up was 75.5 (42 to 95). The principal complications observed were dislocations of the prosthesis (30%) and infections (20%). A need for revision surgery was noted in 30% of patients. No dislocation occurred in patients undergoing osteosynthesis with acetabular reconstruction. We did not note either mechanical loosening of the acetabular component nor thromboembolic complications. In all, 30% of patients presented acute anemia requiring transfusion, and one death was reported. Conclusion. Post-traumatic periprosthetic acetabular fractures frequently have a transverse component that can destabilize the acetabular implant. The frequency of complications, principally dislocations, led to a high rate of revision surgery. Improvements in preoperative planning should make it possible to codify management to reduce this high rate of complications. The best results were obtained when the surgical strategy combined osteosynthesis with acetabular reconstruction. Cite this article: Bone Jt Open 2024;5(1):28–36

Aims. To describe the epidemiology of acetabular fractures including patient characteristics, injury mechanisms, fracture patterns, treatment, and mortality. Methods. We retrieved information from the Swedish Fracture Register (SFR) on all patients with acetabular fractures, of the native hip joint in the adult skeleton, sustained between 2014 and 2020. Study variables included patient age, sex, injury date, injury mechanism, fracture classification, treatment, and mortality. Results. In total, 2,132 patients with acetabular fractures from the SFR were included in the study. The majority of the patients were male (62%) and aged over 70 years old (62%). For patients aged > 70 years, the 30-day mortality was 8% and one-year mortality 24%. For patients aged ≤ 70 years, the 30-day mortality was 0.2% and one-year mortality 2%. Low-energy injuries (63%) and anterior wall fractures (20%) were most common. Treatment was most often non-surgical (75%). Conclusion. The majority of patients who sustain an acetabular fracture are elderly (> 70 years), of male sex, and the fracture most commonly occurs after a simple, low-energy fall. Non-surgical treatment is chosen in the majority of acetabular fracture patients. The one-year mortality for elderly patients with acetabular fracture is similar to the mortality after hip fracture, and a similar multidisciplinary approach to care for these patients should be considered. Cite this article: Bone Jt Open 2023;4(9):652–658

Aims. After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods. A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results. The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion. Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074

Aims. The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. Methods. A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and step-off values in the weightbearing dome were digitally measured by two trauma surgeons. Native hip survival was reported using Kaplan-Meier curves. Predictors for conversion to THA were determined using Cox regression analysis. Results. Of 170 patients, 22 (13%) subsequently received a THA. Native hip survival in patients with a step-off ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively: 94% vs 70% vs 74%). Native hip survival in patients with a gap ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively: 100% vs 84% vs 78%). Step-off displacement > 2 mm (> 2 to 4 mm hazard ratio (HR) 4.9, > 4 mm HR 5.6) and age > 60 years (HR 2.9) were independent predictors for conversion to THA at follow-up. Conclusion. Patients with minimally displaced acetabular fractures who opt for nonoperative fracture treatment may be informed that fracture displacement (e.g. gap and step-off) up to 2 mm, as measured on CT images, results in limited risk on conversion to THA. Step-off ≥ 2 mm and age > 60 years are predictors for conversion to THA and can be helpful in the shared decision-making process. Cite this article: Bone Joint J 2023;105-B(9):1020–1029

Surgical management of acetabular fractures in older patients remains controversial. The purpose of this study is to compare outcomes of primary THA with outcomes after THA for acute acetabular fractures (aTHA) as well as outcomes following delayed THA (dTHA) following prior acetabular fracture. We analyzed data from a large, national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients. We identified all patients undergoing primary total hip arthroplasty THA continuously enrolled in the database at least 2 years prior and after the index procedure. Patients with an initial diagnostic code for acetabular fracture occurring the same day as the THA were classified as acute acetabular fractures. Patients with an initial acetabular fracture diagnostic code occurring at least 6 months before THA were classified as chronic acetabular fractures. The comparator group was patients undergoing THA with no history of acetabular fracture. There were 426,734 patients undergoing primary THA, 235 patients undergoing aTHA and 1,255 patients undergoing dTHA. Patients with an aTHA had higher complication rates, including revisions (9.8% vs 5.6%,), dislocations (8.9% vs 6.4%), and periprosthetic fracture (5.1% vs 2.3%) compared to dTHA. After adjusting for age, sex, region, and comorbidities, receiving an aTHA increased the odds of revision (OR = 3.65 [95% CI: 2.30–5.49]), dislocation (OR = 4.09 [95% CI: 2.53–6.27]), and periprosthetic fracture (OR = 4.29 [95% CI: 2.26–7.36]) compared to primary THA. Receiving a dTHA significantly increased the odds of revision (adjusted OR = 1.80 [95% CI: 1.40–2.27]), dislocation (adjusted OR = 2.50 [95% CI: 1.97–3.13]), and periprosthetic fracture (adjusted OR = 1.99 [95% CI: 1.34–2.83]) compared to primary THA. Patients undergoing aTHA in the treatment of an acetabular fracture have significantly increased rates of revision, periprosthetic fracture, and dislocation compared to dTHA and primary THA

3D printing techniques have attracted a lot of curiosity in various surgical specialties and the applications of the 3D technology have been explored in many ways including fracture models for education, customized jigs, custom implants, prosthetics etc. Often the 3D printing technology remains underutilized in potential areas due to costs and technological expertise being the perceived barriers. We have applied 3D printing technology for acetabular fracture surgeries with in-house, surgeon made models of mirrored contralateral unaffected acetabulum based on the patients’ trauma CT Scans in 9 patients. The CT Scans are processed to the print with all free-ware modeling software and relatively inexpensive printer by the surgeon and the resulting model is used as a ‘reduced fracture template’ for pre-contouring the standard pelvic reconstruction plates. This allows use of the standard surgical implants, saves time on intra-operative plate contouring, and also aids in reduction to an extent. We share through this presentation the workflow of the freeware softwares to use in order to use this surgical planning and implant preparation that may remove the perceived barriers of cost and technology from surgeons that wish to explore using 3D printing technology for acetabular fracture management and may extend applications to other regions

Acetabular fractures present a challenge. Anatomical reduction can be achieved by open reduction and internal fixation (ORIF). However, in elderly patients with complex fracture patterns and osteoporotic bone stock, “fix and replace” has become an option in the management of these injuries. This involves ORIF of the acetabulum to enable insertion of a press fit cup and subsequent cemented femoral stem at the index surgery. A Retrospective analysis of all operatively managed acetabular fractures by a regional Pelvic and Acetabular Trauma service (01/01/2018-30/05/2023) STATA used for analysis. 34 patients undergoing “fix and replace” surgery. Of the 133 patients managed with ORIF, 21 subsequently required Total Hip Arthroplasty (THA). Mean follow up was 2.7 years versus 5.1. There was no statistical significance between the two groups with regards to BMI or sex. Mean age in the “fix and replace” group was 68 compared to 48 in the ORIF and subsequent THA group. This reached statistical significance between the two groups (p=0.001).ASA and Charlson Comorbidity Index (3 and 3 in “fix and replace” and 2 and 1.2 in ORIF to THA group) and Charlson Comorbidity Index both were statistically significantly different (p=0.006 and p=0.027, respectively). High energy mechanism of injury accounted for 56% of the “fix and replace” group compared to 48% in the ORIF to THA. 74% of “fix and replace” were associated fractures compared to 53% of ORIF to THA. Wait to surgery was 3 days for “fix and replace” while 186 days was the mean wait time from listing to THA for the ORIF to THA group. Complication rate was 41% versus 43% in the two groups. 14% in the ORIF to THA group developed PJI versus 6% in “fix and replace”. Fix and replace allows early mobilisation in frailer, elderly patients. Our results show fewer returns to theatre and less PJI in patients having arthroplasty as part of “fix and replace” than subsequent to Open reduction internal fixation

Total hip arthroplasty (THA) is frequently performed as a salvage procedure for the acetabular fracture when posttraumatic osteoarthritis, posttraumatic avascular necrosis, or fixation failure with subluxation develop. Special considerations for this situation include previous surgical exposure with dense scar tissue, the type and location of implants, the location and amount of heterotopic ossification, indolent infection, previous sciatic nerve palsy, and the pathoanatomy of existing acetabular defect. These factors can influence the choice of surgical exposure and the reconstructive method. The outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic degenerative arthritis. Reason for this high failure is the low mean age and the high activity level of the patient. Other important reasons for failure include the problem of acetabular bone deficiency and compromised bone quality. We evaluated the results of cementless THA in patient who had previous acetabular fracture. We also compared this result with those of patients with posttraumatic avascular necrosis of the femoral head. Forty-five consecutive cementless THAs were performed for the treatment of post-traumatic osteoarthritis after acetabular fracture between December 1993 and December 2008. Of these patients, 15 patients were died or lost to follow-up monitoring before the end of the minimum one year follow-up period. This left 30 patients (30 hips) as the subjects of our retrospective review. We evaluated the clinical and radiographic results of these patients and compared with the results of THA in patients with post-traumatic AVN of the femoral head which had without acetabular damage. Two hips required revision of the cup secondary to early migration of the acetabular cup (1 hip) and postoperative deep infection (1 hip). There was no significant difference in clinical and radiographic results between two groups except implanted acetabular component size and required bone graft (p<0.05). The Kaplan-Meier ten-year survival rate, with revision as the end-point, was 90% and 96.7% with loosening of acetabular component as the end-point. Our series suggested that compared with cemented components, uncemented sockets may improve the results of arthroplasty after previous acetabular fracture. In conclusion, cementless THA following acetabular fracture presents unique challenge to the surgeon, careful preoperative assessment and secure component fixation with proper bone grafting is essential to minimize problems

Patients who are Jehovah's witnesses do not accept blood transfusions. Thus, total hip arthroplasty can be challenging in this group of patients due to the potential for blood loss. Multiple strategies have been developed in order to prevent blood loss. A 76-year-old female, Jehovah's witness medicated with a platelet antiaggregant, presented to the emergency department after a fall from standing height. Clinically, she had pain mobilizing the right lower limb and radiological examination revealed an acetabular fracture with femoral head protrusion and ipsilateral isquiopubic fracture. Skeletal traction was applied to the femur during three weeks and no weight bearing was maintained during the following weeks. Posteriorly, there was an evolution to hip osteoarthritis with necrosis of the femoral head. The patient was submitted to surgery six months after the initial trauma, for a total hip arthroplasty. The surgery was performed with hypotensive anaesthesia, careful surgical technique and meticulous haemostasis and there was no need for blood transfusion. Posteriorly, there was a positive clinical evolution with progressive improvement on function and deambulation. Total hip arthroplasty may be safely carried out with good clinical outcomes in Jehovah's witnesses, without the need for blood transfusion, if proper perioperative precautions are taken, as has already been shown in previous studies

Introduction: Factures of the acetabulum are the result of high-energy trauma. Long-term function of the hip joint is compromised in many cases as a result of imperfect reduction, chondral injuries to the acetabulum, femoral head lesion and post-traumatic avascular necrosis of the femoral head.Total hip arthroplasty is one of the treatment option for such patients who present with symptomatic post-traumatic arthritis or avascular necrosis with collapse of the femoral head following acetabular fractures. Materials and Methods: Twenty total hip arthroplasty were performed with use of a cementless cup in 17 patients and cemented cup in a cage in 3 patients for the treatment of posttraumatic osteoarthritis following acetabular fracture. The average age of the 4 women and 16 men was 49 (range, 26 to 86 years) at the time of the arthroplasty. The median interval between the time of injury and the total hip arthroplasty was 37 months (range, 8 to 144 months). The average operative time was 120 minutes and average intraoperative blood loss was 700 ml. Eight patients had previous open reduction and internal fixation of the acetabular fracture and twelve had been treated nonoperatively.Following total hip replacement,each patient was evaluated clinically and radiographically at six weeks, three months, six months and twelve months, and then yearly following total hip replacement. The average duration of clinical and radiographic follow-up was 40 months (range, 26 to 60 months). Results: At the time of final follow-up, of twenty acetabular components, 10 had no evidence of periacetabular radiolucency, 7 components had a partial radiolucency that was < 1 mm wide,2 had a complete radiolucency < 1 mm wide and 1 component was surrounded by a complete radiolucency of > 2 mm in width without showing component migration. According to Engh’s criteria,16 (80%) femoral stems had bony ingrowth and 4 (20%) stems had stable fibrous ingrowth. The average preoperative Harris hip score improved from 35 points to 78 points at the time of final followup. Conclusion: We conclude that total hip arthroplasty for degenerative arthritis following acetabular fractures,is a gratifying but often technically more difficult than a routine total hip arthroplasty because of extensive scarring, heterotopic bone, retained internal fixation devices, and residual deformity of the acetabulum

Introduction: Pelvic and acetabular fracture patients surgically treated have low patient reported outcome compared to a reference population. Our aim was to study quality of life changes during the first 2 years following injury. Methods: All 155 patients (110 male, 45 female, age 16–83) patients with pelvic and acetabular fractures surgically treated Sept 2004-April 2007 were prospectively followed at 6, 12 and 24 months with SF-36. There were 51 pelvic and 104 acetabular fractures. 124 patients answered the questionnaire (80%), and were compared to an age-and-gender matched reference population. Results: Pelvic fracture patients mean scores for physical function (PF) at 6–12–24 months were 59–66–74, and for role physical (RP) 28–47–62. This was below 1 SD from normative PF (mean 91, SD 28) and RP (mean 86, SD 41) at 6 months but not at 12 and 24 months. Acetabular fracture patients mean scores for PF were 51–56–61 and for RP 19–32–45. This was lower than 1 SD from normative PF (mean 85, SD 25) and RP (mean 79, SD 43) both at 6 and 12 months but not at 24 months. SF-36 scores were lower than the reference population in all domains for both fracture groups at the three time points. However mean scores were within 1 SD from normative for the other 6 domains BP, GH, VT, SF, RE and MH at all time points for both fracture groups. Hence improvement in the physical domains PF and RP was reported during the first year in both groups and during the second year for acetabular fractures. Discussion: and Conclusion: We found significant improvement in quality of life physical domains during the first year for both pelvic and acetabular fracture patients, and also during the second year for the latter group

The incidence of acetabular fractures within the UK is about 3 in 100,000 of the population per year. Since Letournel and Judet first proposed that operative reduction and rigid internal fixation of displaced fractures will likely lead to better outcome, operative management of such fractures has become standard management in major trauma centres. Long term outcome results following acetabular surgery have been reported sparingly. Two hundred and fifty-seven displaced acetabular fractures underwent an open reduction and internal fixation at St. George’s Pelvic Unit between 1992 and 1997. All surgery was performed by a single surgeon. 161 patients were followed up prospectively for a minimum of 10 years. Those lost to follow up were excluded. Anthropometric data, fracture pattern, time to surgery, associated injuries, approach, complication and outcome recorded on a database. Modified Merle D’ Auberge score was utilized as outcome measures. The mean age was 36 years (15 to 85). Road traffic accident was the commonest mechanism of injury. We observed simple fractures in 34 % and associated fractures in 66%. 52% suffered polytrauma. Average time to surgery was 11 days and anatomic reduction was achieved in 73.9%. Results were excellent 46.8 %, good 25.5 %, fair 7.5 %, and poor 19.2 %. Poor prognostic factors were increasing age, delayed surgery, poor reduction, and posterior column, transverse posterior wall and T-shaped fracture patterns. Acetabular surgery poses a major challenge to the trauma surgeon. Complications in the immediate, mid and long term are not rare. Our results compare to other series with shorter follow-up. We believe that the gold standard treatment for displaced acetabular fractures must be open reduction internal fixation performed by a dedicated pelvic surgeon at the earliest time possible. Moreover whether we are merely postponing the inevitable post-traumatic arthritis is still unknown

Objective. To investigate the relationship between the pattern of pelvic or acetabular fracture, and bladder injuries. Methods. A total of 173 patients admitted at our Academic Hospital from January 2006 to March 2012 with cystograms done for pelvic or acetabular fractures were studied retrospectively. Records of pelvic X-Rays, CT scans and cystograms were reviewed. Tile's classification and Young & Burgess classification were used for pelvic fractures and Judet & Letournel classification system for acetabular fractures. Results. Out of 173 patients 16% had bladder injuries of which 22% were intra-peritoneal and 70% were extra-peritoneal. The bladder injuries mostly occurred among male patients; 16 males compared to 9 female patients. Out of the 21 fractures of the acetabulum only 2 sustained bladder injury and they were secondary to gunshot wounds. Lateral compression fractures accounted for 67% of bladder injuries. Motor vehicle accidents were the leading mechanism of injury accounting for 117 patients in total and 81% of those with bladder injuries. Among the patients with bladder rupture 55% had at least 3 rami involved and only one patient (4%) with 1 ramus involved had a bladder injury. Overall 44 (34%) of patients with 3 or more rami fractured had bladder injury. Conclusion. Bladder injury appears to be related to the mechanism of injury. We recommend that a cystogram be done routinely when a patient presents with a type III lateral compression fracture. In isolated acetabulum fractures, single ramus fractures and lateral compression type I fractures, request for cystogram should be correlated with clinical signs and symptoms, and not done routinely. NO DISCLOSURES

Introduction: Complex fracture of the acetabulum are difficult to treat. If an osteosynthesis is performed difficult surgery resulted in blood loss, long operating time, high risk of sepsis and failure. Even if the fracture is well operated and ideally stabilised there is a major risk of secondary osteoarthrosis. This can be related to bone necrosis , cartilage surface damage , bone loss. There are also intraoperative risks of neural damage: sciatic nerve as well as gluteus medius nerve. On the other hand , modern surgical technique including an alumina against alumina bearing could allow very long term survival without any activity limitation and this even in very young patients. Secondary procedure after a failed osteosynthesis provides statistically worse functional results than primary total hip. The surgery is more difficult because of hardware retrieval, nerve dissection, bone reconstruction and remaining muscular dysfunction. Materials and Methods: To address these issues we reviewed our results of total hip for acetabular fractures. 80 patients received a total hip for acetabular fracture. From 1980 to 1998: 58 acetabular fractures in 57 patients sustained a total hip: 39 males and 18 females. Mean age: 50 years (from 21 to 80). 35 had had a conservative treatment, 22 had had an osteosynthesis. Delay between fracture and total hip: operated: 10 years, non-operated: 6 years. All prosthesis had an alumina against alumina couple. The stem was always made of titanium alloy, it was smooth, collared and cemented. The socket was plain alumina cemented 8, cement less : 3, metal back alumlina insert: 29, screw in cup with alumina liner: 10, plain polyethylene cemented: 8. Results: Follow-up: from 6 months to 20 years (mean 5,5years). Last Postel Merle d’Aubigne rating: 16,1(8–18) 9 revisions : 1 bipolar aseptic loosening, 8 socket loosening : 2 septic , 6 aseptic. (2 screws in , 6 cemented). There were 22 neural disorder; 19 sciatic palsies; 13 post trauma; 4 post osteosynthesis; 2 post THR; 3 gluteus medius palsy. 7 sepsis: 4 post osteosynthesis, 3 post THR (including 2 post osteosynthesis). Discussion: The results presented were inferior to a regular total hip if an osteosynthesis have been performed previously. Reasons for these inferior results were limp due to previous palsy of gluteus medius nerve, sciatic sequellae, complications of previous sepsis and so on. In contrast cases who had at first orthopaedic treatment followed some weeks later by a total hip experienced very good results. It is difficult to conclude from this limited series. But we are actually on the way to modify our perspectives. Many weak results could have been avoided by doing fine primary surgery. We could expect better functional results with less complications regarding sepsis, nerve damage, muscle preservation if we perform a primary total hip in conjunctions with acetabular reconstruction. Osteosynthesis is still recommended for simple acetabular fracture with large displacement involvement of the posterior wall or one column not comminuted

The purpose of this study was to review the clinical and radiographic outcome in THRs done following acetabular fractures (fx). All patients undergoing conversion THR after previous acetabular fx between 1990 and 2006 at a single institution were identified. Clinical evaluation was done using the Harris hip scale. Radiographic evaluation was done using the system proposed by the Hip society. THRs as part of initial treatment for acute acetabular fx were excluded. There were 90 THRs (90 patients) performed in patients previously treated for an acetabular fracture. At the time of their acetabular facture, 67 had been treated with ORIF, 12 were treated with closed or limited open reduction and percutaneous fixation, and 11 were treated without surgery. The mean age at injury was 43.7 years, (range, 14–79). 68 patients sustained their fx from a high-energy mechanism (MVC, MPC, or MCC). Three patterns accounted for 52% of the fx: transverse posterior wall (20), both column (18), and T-Type (9). Associated pelvic fractures were present in 14 patients. Associated ipsilateral proximal femur fractures were present: femoral head (four), femoral neck (five), and femoral shaft (three). Among those treated with ORIF, marginal impaction was noted in 31 and osteo-chondral head damage in 32 hips. The mean interval between injury and THR was 42 months (range, two months to 32 years). Cement-less fixation was used in 81 of the 90 cups. Similarly, cementless stems were used in 80 stems. Bone graft was necessary in 26 patients (17 autograft, nine allograft). Two cases each required pelvic augments and reinforcement cage, respectively. Additional findings at THR included: femoral head erosion (53 hips), femoral head osteonecrosis (37 hips), osteonecrosis of the acetabulum (22 hips), and fx non-union (six hips). The average cup abduction angle was 440 (range, 28 to 60), the average cup height was 24 mm (range, 10 to 42), and the average medialization distance was 23 mm (range, 5 to 48). The mean EBL was 810 ml and mean operative time was 195 minutes. The mean F/U was 36 months (range, 6 months to 17 years). The median Harris hip score was 89 at the most recent F/U. Fifteen revisions (16%) have been done: aseptic loosening (seven hips), recurrent dislocation (six hips) and infection (two hips). Five of the six revisions for recurrent dislocation were performed in patients who had a posterior approach for both their acetabular fracture treatment and their THR. No revision was done in those who had been initially with percutaneous fixation. There was no infection in those who had been initially with percutaneous fixation either from the fx treatment or the THR. In contrast, 14 ORIF patients were complicated by infection. One of these developed infection following THR. Our data support the clinical efficacy and mid-term durability of THR in this patient group. Aseptic loosening and recurrent dislocation remain the primary reasons for revision surgery

Purpose: The purpose of this study was to evaluate total hip arthroplasty in the treatment of post-traumatic arthritis following acetabular fracture and to compare the long-term outcome of THA after previous open reduction and internal fixation or conservative treatment of the acetabular fracture. Methods: Thirty-four patients (thirty-six hips) underwent total hip arthroplasty for arthritis resulting from an acetabular fracture. The mean age at the time of hip arthroplasty was 49 years. The mean follow-up was eight years and nine months (range, 4–17 years). The mean interval from fracture to arthroplasty was 7.5 years (range, 5 months-29 years). Twenty-three hips had been previously treated by open reduction and internal fixation and 12 hips had a conservatively treated fracture. An uncemented arthroplasty was performed in 31 hips, cemented arthroplasty in 2 patients and a hybrid replacement in 2 patients. Results: Only 16 patients achieved and maintained a good to excellent result over the course of the follow-up. The mean Harris hip score improved from 44.5 points preoperatively to 72.76 points for operatively treated fractures (23 patients). The mean Harris hip score improved from 44.2 points preoperatively to 78.7 points for conservatively treated fractures (12 patients) (p> 0.05). Ten out of 35 hips required revision; 9 were revised because of aseptic loosening and one for infection with a total revision rate of 29%. Femoral bone quality was significant in predicting revision. No femoral radiographic loosening was found at latest follow-up. On the acetabular side, the rate of radiographic loosening was higher. There was no significant difference in bone grafting, heterotopic bone formation, revision rate, operative time and blood loss between the two groups (ORIF vs conservative treatment of acetabular fracture) (p> 0.05). Conclusions: Outcome following total hip arthroplasty in the treatment of post-traumatic arthritis following acetabular fracture is less favourable than following primary osteoarthritis. Those patients initially treated conservatively had similar long term results compared to those treated primarily by open reduction and internal fixation. At long term follow-up, the main problem identified was osteolysis and acetabular wear

Background and Objective. Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic arthritis after acetabular fracture for many years. However, the midterm and long-term results of THA for this unique population are still controversial. According to previous studies, we found that uncemented acetabular reconstructions were usually performed in patients who were most likely to have the best results and an abnormal acetabular structure was usually the reason for THA failure. In this study, we evaluated the midterm results of using uncement acetabular components to treat posttraumatic arthritis after acetabular fracture. In addition, we investigated the effects of different acetabular fracture treatments and fracture patterns on THA. Materials and Methods. Between January 2000 to December 2003, 34 uncemented acetabular reconstructions were performed in 34 patients for posttraumatic arthritis after acetabular fractures. Among them, 31 patients underwent complete clinical and radiographic follow-up for an average of 6.3 years (range, 3.1–8.4 years). There were 22 men and 9 women. The patients' average age was 51 ± 12 years (range, 27–74 years) at the time of arthroplasty. The average interval from fracture to THA was 5.58 ± 4.42 years (range, 0.75–17.5 years). Of the 31 patients, 19 had undergone ORIF (open-reduction group) and 12 had received conservative treatment for the acetabular fractures (conservative-treatment group). Then, 14 had simple pattern fractures (simple group) and 17 had complex pattern fractures (complex group). After midterm follow-up, the radiographic and clinic results of the different groups were compared. Results. During 6.3 years' follow up, no infection occurred and no revision was needed in the 31 patients. In the open-reduction and conservative-treatment groups, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 138 ± 29 minutes and 98 ± 16 minutes (P < .001), 726 ± 288 mL and 525 ± 101 mL (P = .01), and 1,130 ± 437 mL and 1,016 ± 422 mL (P = .62). In the complex group and the simple group, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 132 ± 28 minutes and 109 ± 31 minutes (P = .042), 741 ± 221 mL and 536 ± 248 mL (P = .02), and 1,100 ± 414 mL and 1,075 ± 456 mL (P = .91). The average Harris Hip Score increased from 49 ± 15 before surgery to 89 ± 5 in the latest follow up, and 29 patients (94%) had either excellent or good results. The average Harris Hip Score for the open-reduction group and the conservative-treatment group increased to 87 ± 6 and 91 ± 3 (P = .07), respectively, after surgery; for the complex group and the simple group, it increased to 88 ± 6 and 90 ± 4 (P = .25), respectively. There was no significant difference between the open-reduction group and the conservative-treatment group or between the complex group and the simple group regarding the number of hips with excellent and good results. Of our 31 patients, none had a change in acetabular component abduction of >4°. The average horizontal migration of cup was 1.48 ± 0.46 mm (range, 0.7–2.33 mm), and the average vertical migration was 1.41 ± 0.54 mm (range, 0.5–2.51 mm). The average rate of polyethylene liner wear was 0.25 ± 0.11 mm/y (range, 0.03–0.41 mm/y). Average wear rates were 0.25 ± 0.12 mm/y and 0.24 ± 0.11 mm/y for the open-reduction group and the conservative-treatment group (P = .72), respectively, and 0.24 ± 0.13 mm/y and 0.26 ± 0.10 mm/y in the complex group and the simple group (P = .67), respectively. The average rate of polyethylene wear for all patients was positively related to BMI (r = .36; P = .047). After THA, all 31 patients had a reconstructed hip center within 20 mm of vertical and horizontal symmetry compared with the contralateral hip, including 27 patients (87%) with anatomic restoration and 4 patients with reconstructed hip center between 10–20 mm of vertical and horizontal symmetry. Anatomic restoration was positively related to fracture treatment (r = .48; P = .006), but it had no relation to fracture pattern (r = .16; P = .40). Conclusion. Uncement acetabular reconstruction following acetabular fracture had favorable midterm results. Fracture treatments and patterns are associated with increased operative time and hemorrhage amount. Open reduction and internal fixation of fracture favours anatomic restoration of hip rotational center

Purpose: The purpose of this work was to analyse different techniques and outcome of total hip arthroplasty for acetabular degeneration after orthopaedically or surgically treated fracture of the acetabulum. Material and methods: This retrospective analysis of a consecutive series was conducted by an independent observer. Sixty-four arthroplasties in 63 patients performed between 1979 and 2000 were included. Twenty-eight acetabular fractures had been treated surgically and 36 orthopaedically. Five types of cups were implanted (25 cerafit, 3 cerapress, 17 cemented alumina, 11 screwed, 7 polyethylene). All patients were assessed preoperatively and at last follow-up with the Merle d’Aubigné clinical scale. The postoperative and last follow-up radiograms were assessed according to Charnley and De Lee. Operative difficulties were assessed in terms of operative time, blood loss, and analysis of the operation reports. Actuarial survival was calculated. Results: Mean follow-up was five years two months. Six patients were lost to follow-up early. Clinical outcome was satisfactory with significant improvement in the Merle d’Aubigné score. The 10-year survival rate was 81% taking aseptic loosening as the endpoint and 74% taking surgical revision as the endpoint. Operative time and blood loss were significantly related to loss of ace-tabular bone stock and to operator experience (p < 0.05). Survival was significantly related to acetabular bone defect (p < 0.05). There was no difference between the treatment modes used for the initial acetabular fracture for peroperative difficulty or survival. Discussion: Total hip arthroplasty for acetabular degeneration secondary to acetabular fracture has given good functional results. Long-term survival is below that for primary arthroplasty, the only unfavourable factor identified being loss of acetabular bone stock. The surgical procedure is more difficult and requires a certain experience. We did not find any difference related to the type of treatment (orthopaedic or surgical) used for the initial acetabular fracture. It was difficult to interpret the influence of cup type due to the wide range of cups used in this series

Severe acetabular fractures are difficult to treat. Complications include blood loss, neural damage, long operating times, and a high risk of sepsis and failure. Even when the fracture is ideally stabilised, there is a major risk of secondary osteoarthritis. This can be related to bone necrosis, cartilage surface damage, bone loss. However, even in young patients modern surgical techniques, including use of an alumina-against-alumina bearing, may facilitate long-term survival without limitation of activity. Functionally, the results of secondary procedures after failed osteosynthesis are statistically worse than after primary total hip arthroplasty (THA). The surgery is difficult because of material retrieval difficulties, nerve dissection, bone reconstruction and remaining muscular dysfunction. We reviewed the results of 80 THA procedures done between 1980 and 1998 to treat 58 acetabular fractures. The mean age of our 57 patients (39 men and 18 women) was 50 years (21 to 80). The mean delay between fracture and THA was 10 years in 22 patients who had undergone osteosynthesis and six years in 35 patients who had been treated conservatively. The mean follow-up period was 5,5 years (6 months to 20 years). There were eight instances of socket loosening, two of which were septic and six aseptic. Two of these patients had screw-in prostheses and six had cemented. There were 19 sciatic palsies, 13 of which developed after trauma, four after osteosynthesis and two after THA. There were three cases of gluteus medius palsy. In two of four cases of sepsis that occurred after osteosynthesis, sepsis recurred after THA, and in one patient sepsis developed after THA. In this limited series, patients who underwent THA after osteosynthesis did not have as good an outcome as those in whom initial orthopaedic treatment was followed some weeks later by THA. We believe many poor results could have been avoided with better primary surgery. Functional results are likely to be better, and the incidence of complications lower, if primary THA is performed in conjunction with acetabular reconstruction. Of course, for treatment of simple acetabular fracture involving major displacement of the posterior wall, one column osteosynthesis is still recommended