CORR Insights^®: Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications

Excerpt

The optimal treatment for acetabular fractures remains unclear, varying from nonoperative management for nondisplaced and minimally displaced fractures, to open reduction and internal fixation, with or without subsequent THA. This controversy arises from the fact that regardless of how patients are treated, many do not do well. Patients treated nonoperatively have a difficult, long, and inconsistent recovery [1, 8]. As many as 67% of patients treated with ORIF develop posttraumatic arthritis [9], while many patients treated with THA, either acutely (at the time of the acetabular fracture [5]) or even later on, develop complications related to the arthroplasty [9, 10]. For example, in patients who undergo delayed THA following ORIF, scar tissue, poor bone quality, and pelvic deformity make surgery challenging, and implant survivorship ranges from 76% to 87% at 10 years secondary to a high risk of aseptic loosening [3]. Because of this, some orthopaedists have advocated for acute or immediate THAs for fracture treatment to avoid problems associated with revision surgery down the line [2]. Other studies showed improved survivorship with this approach (up to 95% 10-year survival), but little has been reported with this approach for the long-term [9]. Additionally, there are proponents for different implant types, such as cementless or cemented prostheses, or the use of porous metal components [11]. …