Long-Term Outcome of Secondary Joint Replacement after Acetabular Fracture

Abstract

Background: Patients with acetabular fractures frequently develop osteoarthritis, femoral head osteonecrosis, or heterotopic ossification. Secondary total hip arthroplasty (THA) seems a possible salvage procedure, but little is known about its long-term outcome in these individuals.

Patients and Methods: At our institution, 37 patients aged 20–74 years (median 44 years) underwent secondary THA 4–235 months after having sustained an acetabular fracture. Most joints were severely osteoarthritic, five had apparent femoral head necrosis. 28 cups and 20 stems were implanted without cement, and two patients received thrust plate devices.

Results: 22 patients were available for follow-up after 48 (15–168) months. Questionnaires only could be obtained from seven additional individuals. Three patients had revision surgery for aseptic loosening, four because of recurrent dislocations, and six for other reasons. The outcome was rated very good in ten, good in five, fair in two, and poor in five according to Merle d'Aubigné/Postel. Seven patients returned to their original job, seven found a different employment, and 10 were unemployed, retired or received payments from workmen's compensation funds. Patients with a good outcome were younger and had a shorter interval between trauma and THA.

Conclusions: Secondary THA yields excellent or good score results in the majority of patients despite a high revision rate. Reintegration into the work force is successful especially amoung younger patients, who seem to benefit most from this salvage procedure.