Indications and technical challenges of total hip arthroplasty in the elderly after acetabular fracture

Abstract

Introduction: With people living longer and healthier lives, acetabular fractures in the elderly are becoming more common. But these fractures are still much less common than proximal femur fractures. Because of an insufficient number of cases, prospective studies with good statistical power have not yet been performed. Nevertheless, a collective, multicentre analysis of these injuries and their prognosis would help to define clinical practice recommendations.

Material and methods: As with younger subjects, the initial assessment for acetabular fractures in the elderly must be comprehensive and include detailed radiological evaluation and precise analysis of the fracture. Accurate diagnosis of the fracture type and displacement will allow the surgeon to follow a decision tree, with options ranging from functional treatment to emergency total hip arthroplasty (THA), depending on the patient's condition.

Conclusion: THA treatment of these fractures is challenging for the surgeon in several aspects. These include determining the waiting time before the procedure, selecting the surgical approach, problems related to any existing hardware, need for bone grafting, primary fixation of the cup, dislocation risks, and the patient's ability to recover from an extensive and often complex surgery.

Level of proof: Level V: expert opinion.

Keywords: Acetabulum; Bone fixation; Elderly; Fracture; Hip replacement.