Total Hip Arthroplasty after Acetabular Fracture: Acute Phase and Delayed Phase

Hwan-Hee Lee; Se-Won Lee; Se-Won Weon-Yoo

doi:10.12671/jkfs.2019.32.4.232

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Lee, Lee, and Weon-Yoo: Total Hip Arthroplasty after Acetabular Fracture: Acute Phase and Delayed Phase

Original Article

J Korean Fract Soc 2019;32(4):232-239.

Published online: 10 January 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.4.232

Total Hip Arthroplasty after Acetabular Fracture: Acute Phase and Delayed Phase

Hwan-Hee Lee, M.D., Se-Won Lee, M.D., Ph.D.*, Se-Won Weon-Yoo, M.D., Ph.D.

Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Daejeon Korea

Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul Korea

Correspondence to: Weon-Yoo Kim, M.D., Ph.D. Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea Tel: +82-42-220-9530 Fax: +82-42-221-0429 E-mail: weonyookim@gmail.com

Financial support: None. Conflict of interests: None.

Received 29 September 2019 Revised 7 October 2019 Accepted 7 October 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The incidence of acetabular fractures in the elderly has increased because of the increasing elderly population. To determine the treatment plan for acetabular fractures, the patient's age, gait ability, presence or absence of osteoporosis and osteoarthritis, underlying disease, and fracture pattern should be considered. The application of total hip arthroplasty for acetabular fractures with the proper indications can be expected to have a good prognosis. In this paper, the application of total hip arthroplasty as a treatment method for acetabular fractures is divided into acute and delayed phases.

Keywords: Arthroplasty, Hip, Acetabulum, Osteoarthritis

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Fig. 1.

(A) Preoperative anteroposterior radiograph of a 77-year-old male showed a posterior wall fracture with osteoporosis. (B, C) Computed tomography scan showed severe comminuted fracture of the posterior wall of the acetabulum and impaction of the femoral head. (D) Postoperative anteroposterior radiograph after internal fixation with total hip arthroplasty. (E) Four-year postoperative radiograph showed stable total hip component with bone union.

Fig. 2.

(A) Preoperative anteroposterior radiograph of a 67-year-old male showed a transverse fracture with posterior wall fracture of the acetabulum and severe impaction. (B, C) Computed tomography showed a severe comminuted fracture of the posterior wall and protrusion of the femoral head. (D) The acetabular mesh plate was inserted into the acetabulum through the Kocher–Langenbeck approach. (E) Autogenous corticocancellous bone from the femoral head was grafted on a mesh plate to support the acetabular cup. (F) A liner was inserted after fixation of the cemented flanged acetabular cup. (G) Postoperative anteroposterior radiograph after internal fixation and total hip arthroplasty. (H) Three-year postoperative radiographs showed stable total hip arthroplasty.

Fig. 3.

(A) Preoperative anteroposterior radiograph of a 50-year-old male showed a transverse fracture with a posterior wall fracture of the acetabulum. (B, C) The three-dimensional reconstruction images showed the impaction of acetabulum and comminuted fragments. (D) Postoperative anteroposterior radiograph after internal fixation through the Kocher–Langenbeck approach. (E) Seven-month postoperative radiographs showed post-traumatic osteoarthritis on the left hip joint. (F) Intraoperatively, the resected femoral head showed denuded and destroyed articular cartilage. (G) Postoperative anteroposterior radiograph after total hip arthroplasty. (H) Five-year postoperative radiographs showed a stable total hip component with no complaint.

Table 1.

Indications for Acute Total Hip Arthroplasty in Acetabular Frac-

tures
• Poor bone quality
• Intraarticular comminution
• Impaction of femoral head or acetabulum
• Associated femoral head or neck fractures
• Preexisting hip osteoarthritis

Table 2.

Indications for Delayed Total Hip Arthroplasty in Acetabular Fractures

• Medically compromised patient
• Nonunion after conservative treatment or operation
• Arthritic change
• Osteonecrosis of femoral head
• Infection should be ruled out

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