Acute Total Hip Replacement for Displaced Acetabular Fractures in Older Patients

Primary total hip arthroplasty (THA) has been suggested for old patients with acetabular fractures, because it permits immediate full weight bearing and precludes secondary surgery for posttraumatic osteoarthritis. The authors retrospectively analyze the outcome after 35 primary THAs performed between 1982 and 2001 focusing on complications, functional impairment and pain. 19 patients were available for a follow-up after a median of 6 years. Seven patients had died and nine were lost to follow-up. Among those available for follow-up, four were severely handicapped or required regular analgesic medication. By contrast, four were able to work regular hours or to engage in sports activities. Eight patients had undergone various revision procedures. Primary THA is an option for the treatment of acetabular fractures in aged or chronically ill patients as well as for individuals with concomitant osteoarthritis at the time of fracture. However, complications are not infrequent and a solid buttress achieved, e. g., by a roof reinforcement ring (“hemispherical plate”) is considered crucial for a successful outcome.