Total hip arthroplasty following open reduction and internal fixation for displaced acetabular fractures

Fractures of the acetabulum are difficult to treat and even after fixation they can lead to posttraumatic arthritis and avascular necrosis of the femoral head. Total hip arthroplasty has been the most common surgery performed for the complications of posttraumatic arthritis and avascular necrosis of the femoral head. Aim: To evaluate the links between acetabular fracture type, radiological and clinical outcomes of open reduction and internal fixation, and clinical outcomes of total hip arthroplasty. Material and methods: One hundred thirty-two patients with acetabular fractures were treated surgically at the Trauma Department of “Sf. Spiridon” County Clinical Emergency Hospital from Iasi. Fifteen patients underwent THA for posttraumatic osteoarthritis or femoral head avascular necrosis following open reduction and internal fixation for acetabular fractures. Clinical and radiographic examinations were performed at 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. Patients were assessed clinically using the Harris Hip Score and radiologically with Matta outcome grading. Heterotopic ossification was classified according to Brooker grading. Results: Mean Harris Hip Score has improved from 55 before conversion to 90 at 6 months after THA. No dislocation, deep vein thrombosis or pulmonary thromboembolism, new nerve injury, and heterotopic ossification occurred. Conclusions: The conversion to total hip arthroplasty after posttraumatic arthritis and avascular necrosis of the femoral head in acetabular fracture can lead to reasonable pain relief and functional improvement.