Background: We assessed the role of acute total
hip arthroplasty in a selected group of patients with a displaced
acetabular fracture and complicating features that greatly diminished
the likelihood of a favorable outcome after open reduction and internal fixation.
Methods: Between 1985 and 1997, fifty-seven patients
underwent an acute total hip arthroplasty for a displaced acetabular
fracture. Patients were followed for a mean of 8.1 years (range,
two to twelve years). The mean time from the injury to the arthroplasty
was six days (range, one to twenty days). The mean age of the patients
at the time of the arthroplasty was sixty-nine years (range, twenty-six
to eighty-nine years). Indications for the acute arthroplasty included
intra-articular comminution as well as full-thickness abrasive loss
of the articular cartilage, impaction of the femoral head, and impaction
of the acetabulum that involved >40% of the joint
surface and included the weight-bearing region.
Results: At the time of the latest follow-up, the
mean Harris hip score was 89 points (range, 69 to 100 points); forty-five
patients (79%) had an excellent or good outcome. There
were six cases of heterotopic bone formation, including one of symptomatic
grade-IV ossification. During the initial six postoperative weeks,
the acetabular cups subsided an average of 3 mm medially and 2 mm
vertically. All of the cups then stabilized, and none were loose
at the latest follow-up evaluation. Six patients had excessive medialization
of the cup, but none had late loosening or osteolysis. Nine cups
(16%) had notable polyethylene wear, but none were revised.
No cup or stem had late clinical or radiographic evidence of loosening.
There were three late procedures: one for revision of a malaligned cup
because of recurrent dislocations, one for removal of hardware from
the greater trochanter, and one for excision of heterotopic bone.
Conclusions: In selected patients with a displaced
acetabular fracture that has a low likelihood of a favorable outcome
after fracture treatment, an acute total hip arthroplasty may provide
an alternative means with which to achieve a painless, mobile hip. These
complex procedures are best undertaken by a surgical team with substantial
experience with both acetabular trauma and hip arthroplasty.