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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2003 February;54(1):1-11
Total hip arthroplasty for post-traumatic arthritis after acetabular fracture
Bellabarba C., Barei D. P., Mills W. J., Nork S. E., Chip Routt M. L. Jr.
Department of Orthopaedics and Sports Medicine Harborview Medical Center University of Washington School of Medicine, Seattle, WA, USA
Total hip arthroplasty (THA) for post-traumatic arthritis after acetabular fracture poses several challenges due to the combination of unfavorable patient demographics and increased surgical complexity. The young age and high activity level of post-traumatic arthritis patients may be associated with exceedingly high demands that compromise the longevity of their hip prostheses. Acetabular bone deficiency and soft tissue injury are 2 of the many post-traumatic issues that increase the complexity of THA and may negatively influence results. Because of these considerations, patients undergoing THA after acetabular fracture have more complications and worse component longevity than patients undergoing THA for non-traumatic conditions. However, results of THA after acetabular fracture may be optimized by anticipating certain frequently encountered intraoperative challenges and by appreciating the effect of different surgical techniques on treatment results. Regardless of whether acetabular reconstruction is performed with cement, excellent short-term clinical results can be expected. As duration of follow-up increases, however, initially positive results deteriorate to a much greater degree with cemented than with non-cemented acetabular components. Whereas long-term follow-up studies have shown unacceptably high rates of aseptic loosening with cemented acetabular reconstruction, the main long-term problem with non-cemented acetabular components is polyethylene wear. Acceptable results with THA after acetabular fracture are possible using strategies that help prevent common complications such as heterotopic ossification and infection, and which effectively address frequently encountered intraoperative challenges related to bone deficiency and hip instability. The lower rate of aseptic loosening has made non-cemented acetabular reconstruction the technique of choice after acetabular fracture.