Acute Total Hip Arthroplasty for the Treatment of Acetabular Fractures: A Retrospective Study With a Six-Year Follow-Up

Abstract

Objectives While open reduction and internal fixation is considered the gold standard for the treatment of acetabular fractures, it is associated with significant complications due to prolonged immobilization for elderly patients. The aim of this study was to investigate the clinical and radiological outcomes in elderly patients treated with an acute total hip arthroplasty (THA). Patients and methods This retrospective study included 16 patients (10 women and 6 men) with a mean age of 80.1 years suffering from a displaced acetabular fracture after a low-energy trauma. Primary THA was performed in all cases, by the same surgeon, within a three-week period after the fracture. The Burch-Schneider reinforcement ring with a cemented cup was used in 10 patients and a jumbo acetabular cup was used in 6 patients, whereas autologous bone graft was used in all cases. Results With a mean follow-up of 72 months, one dislocation occurred that was treated with close reduction, and one patient developed superficial site infection that was managed conservatively with antibiotics. No periprosthetic fractures, deep infections, or other adverse events were observed. One case of asymptomatic radiographic loosening was reported and treated conservatively. And autologous bone graft was well incorporated. Clinical scores were significantly improved, and all patients were able to walk independently. Conclusions Acute THA for the treatment of displaced acetabular fractures in elderly patients seems to be a safe option with good functional and radiological outcomes and low complication rates, offering early mobilization and weight-bearing ability to elderly patients.

Keywords: acetabular fracture; acute treatment; elderly; jumbo acetabular cup; reinforcement ring; tha.

Figure 1. Preoperative X-ray of an 81-year-old patient with an acetabular fracture

Figure 2. Preoperative CT reconstruction of the same patient

Figure 3. Radiograph of the same patient three months postoperatively

Figure 4. Radiograph of the same patient one year postoperatively

Figure 5. Radiograph of the same patient six years postoperatively (heterotopic ossification, Brooker III type, as marked by the white arrow)

Figure 6. Preoperative CT and reconstruction of an 83-year-old patient with an acetabular fracture

Figure 7. Radiograph of the same patient postoperatively

Figure 8. Radiograph of the same patient one year postoperatively

Figure 9. Asymptomatic aseptic loosening of the acetabular component in an 87-year-old patient at the six-year follow-up, as shown by the white arrow