Instructional Course Lecture   |    
Primary Total Hip Arthroplasty After Acetabular Fracture*
Dana C. Mears, M.D., Ph.D.; John H. Velyvis, M.D.
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, Maryland 21224-2780. E-mail address: dcmo1@gateway.net.
Division of Orthopaedic Surgery, Albany Medical Center, 47 New Scotland Avenue, Suite A300A, Albany, New York 12208-3479. E-mail address: jhv1@hotmail.com.

J Bone Joint Surg Am, 2000 Sep 01;82(9):1328-1328
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After a displaced acetabular fracture, a patient may be predisposed to the development of symptomatic posttraumatic degenerative arthritis of the hip joint or avascular necrosis of the femoral head. In selected patients, a total hip arthroplasty may eventually be necessary irrespective of the method of initial management1-3. On the basis of a review of the results described by Letournel and Judet2 and Matta4 and on the basis of our experience, we determined that the likelihood that treatment will culminate in an arthroplasty is related to the initial type of fracture; the magnitude of the provocative force; the age and weight of the patient; and, when the initial management of the fracture was open reduction and internal fixation, the duration of the delay from the injury to the surgical procedure. When the initial acetabular deformity is relatively minor and when the acetabulum unites, especially following nonoperative treatment, a conventional arthroplasty is likely to lead to an uncomplicated recovery and a satisfactory outcome. Nevertheless, in selected cases, one or more complicating factors may be encountered. Following nonoperative treatment of an acetabular fracture, residual displacement may hamper a subsequent arthroplasty because of an occult or frank nonunion of the acetabulum or possibly because of a malunion or a malaligned nonunion5. When the initial management of an acetabular fracture was surgical, a belated arthroplasty performed to manage posttraumatic arthritis may be impeded by dense scar tissue, heterotopic bone, avascularity of the hip muscles or the acetabulum, obstructive hardware, or occult infection6. On the basis of a review of the few prior studies in the literature7-10, we found that the overall prognosis for a patient managed with a total hip arthroplasty after an acetabular fracture is less favorable than that for one managed with an arthroplasty performed because of primary degenerative arthritis. In the present study, we address the principal concerns regarding management with total hip arthroplasty after initial treatment of an acetabular fracture with closed or open reduction.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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