TOTAL HIP REPLACEMENT IN NEGLECTED FRACTURES OF THE ACETABULUM

Abstract

Neglected fractures of the acetabulum have been defined as those fractures that present to the surgical team after 3 weeks from the time of injury. Total hip arthroplasty in these cases often require a major acetabular reconstruction.

From 1989 until 2005, 38 total hip replacements were implanted in Cairo, Egypt for neglected acetabular fractures, with a follow up between 6 months and 192 months.

The male to female distribution was 33/5. The age distribution ranged from 22 to 70 years with a mean value of 47.7 years. In 30 cases, hip arthroplasty was carried out as a primary procedure due to associated acetabular cartilage damage beyond reconstruction and/or associated articular cartilage or structural damage to the femoral head. 8 cases were done after a previous attempt of open reduction and internal fixation due to failure of the reduction and fixation, avascular necrosis and/or infection.

34 acetabular components were treated by internal fixation of the columns if still mobile, autografts from the femoral head with cemented acetabular components. Four uncemented acetabular components were used in selected cases when a stable reconstructed acetabular rim was achieved. All femoral stems were cemented with the exception of five cementless stems.

At the last follow up, all grafted acetabular defects were taken with very satisfactory fixation in cemented cups. Three delayed acetabular loosening occurred at 13 years due to uncoupling of metal backed cemented acetabular components. Cementless acetabular components showed union of the fracture with stable acetabular fixation. The Merle D’Aubigne score was changed in all the cases from a range of 4/5 to 15/18.

We believe that neglected acetabular fractures can be satisfactorily treated by cemented total hip replacement using internal fixation of the columns and acetabular grafting.