Introduction: The purpose of this retrospective study was to report on the minimal 5-year follow-up results of a consecutive series of cemented total hip arthroplasties following acetabular fracture.

Materials and methods: Between January 1980 and December 1995, fifty-three total hip arthroplasties were performed in 53 patients (16 females and 37 males). The mean age of the patients at the time of the index arthroplasty was 53.1 years (range, 24–84 years). The initial fracture concerned one wall in 18 patients, one column in 7, and both columns in 6. It was a complex fracture in 11 patients, and was unknown in the remaining 11 patients. Twenty-three of the 53 fractures had had a non-operative treatment, while 30 had had a surgical treatment. The mean time between the fracture and the arthroplasty was 16.4 10.8 years. All prostheses were of Charnley-Kerboull design, combining a 22.2-mm femoral head and an all-polyethylene socket. Both components were cemented.

Results: At the minimum 5-year follow-up evaluation, 35 patients were still alive and had not been revised at a mean of 12.4 3.8 years (range, 7–21 years), 6 patients had been revised, 5 patients had died from unrelated causes, and 7 patients were lost to follow-up. The mean Merle d’Aubigne hip score was 16.7 1.3 at the latest follow-up. Revision was performed for high polyethylene wear associated with periprosthetic osteolysis in 5 hips at a mean of 10.3 years, and for deep sepsis in one. The survival rate of the whole series at 15 years, using revision for any reason as the end-point, was 79.2 9.7 % (95% confidence interval, 60.3 to 98.2%). The survival rate at 15 years, using radiologic loosening as the end-point, was 94.7 % (95% confidence interval, 84.7 to 100%) for hips of which fracture had been treated non-operatively, versus 75.5 13.0% (95% confidence interval, 49.9 to 100%) for hips of which fracture had been surgically treated. The difference was not significant with the numbers available (log-rank test, p = 0.44).

Discussion and conclusion: The results of this series indicated that the mechanical failure rate of total hip arthroplasty following acetabular fracture was high in the mid- to long-term. The young age of the patients, the predominantly male cohort, and the modifications of the acetabulum structure due to the fracture could account for this phenomenon.

Purpose: The purpose of this retrospective study was to evaluate at minimal 5 years follow-up outcome in a consecutive series of total hip arthroplasties implanted for fracture of the acetabulum.

Material and methods: The series included 53 arthroplasties implanted between January 1980 and December 1995 in 53 patients, 16 women and 37 men, mean age 53.1 years (24–84). The initial fracture involved the acetabular wall in 18 patients, one column in seven and two columns in six. It was a complex fracture in eleven cases and classification was unknown in the eleven other hips. Orthopaedic treatment was used for 23 patients and surgery for 30. Mean time between fracture and arthroplasty was 16.4±10.8 years. Cemented Charnley-Kerboull implants with a metal-polyethylene bearing were used. The Postel-Merle-d’Aubigné (PMA) score was used to assess functional outcome. The actuarial survival was determined.

Results: At five years minimum follow-up, 33 patients were alive and had not undergone revision at mean follow-up of 12.4±3.8 years (7–21). Six patients had had revision of the acetabular and/or femoral element, five patients had died, and seven were lost to follow-up. Revisions were required for cup wear associated with periacetabular osteolysis. The mean preoperative functional score was 10.6±2.5 versus 16.2±2.8 (8–18) at last follow-up (Wilcoxon rank test, p< 0.0001). Cumulative survival, taking revision as failure, was 90.3±6.5% at 15 years (95%CI 77.6–100%) for hips treated orthopaedically versus 66.5±14.5 (95%CI 38.1–94.9%) for hips treated surgically. The difference for the analyzable hips was not significant (logrank, p=0.69).

Discussion: The results of this series confirm that the long-term risk of mechanical failure of total hip arthroplasty for fracture of the acetabulum is high.