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Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management.

Methods

We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59 years (20–94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5 years (2–13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d’Aubigné (PMA) scores and Brooker classification.

Results

The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (β = −4.2), HHS (β = −7.8), and PMA (β = −2.2) scores at mean 5 years (2–13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10 years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p < 0.001).

Conclusion

Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10 years in a medically vulnerable patient population.

Level of Evidence

Level 3; Therapeutic study.

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Data availability

Regarding the French law (Jardé, 18Nov2016, https://solidarites-sante.gouv.fr/systeme-de-sante-et-medico-social/recherche-et-innovation/recherches-impliquant-la-personne-humaine/), retrospective data collection does not require the approval of an IRB. Data protection was maintained as all the data have been collected in agreement with an appropriate procedure in the University Hospital of Toulouse.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. None of the authors, or any member of their family, have received any financial remuneration related to the subject of the article.

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Author notes

  1. G. Gracia and P. Laumonerie participated equally in this research.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France

    G. Gracia, P. Laumonerie, E. Cavaignac, P. Chiron & N. Reina

  2. Department of Orthopaedic Surgery, Polyclinique Côte Basque Sud, 7 Rue Leonce Goyetche, 64500, Saint-Jean-de-Luz, France

    G. Gracia

  3. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    M. E. Tibbo

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  1. G. Gracia
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Contributions

G. Gracia contributed to conception and design, data acquisition, critical revisions, manuscript review, and study supervision. P. Laumonerie contributed to conception and design, analysis and interpretation, critical revisions, manuscript review, statistical analysis, and study supervision. M. E. Tibbo, E. Cavaignac, and P. Chiron contributed to critical revisions and manuscript review. N. Reina contributed to critical revisions, manuscript review, and administration and approved final version of paper.

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Correspondence to G. Gracia.

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Gracia, G., Laumonerie, P., Tibbo, M.E. et al. Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture. Eur J Orthop Surg Traumatol 33, 51–60 (2023). https://doi.org/10.1007/s00590-021-03157-z

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