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Acute Total Hip Arthroplasty for Fracture of the Acetabulum

  • Jeffrey O. Anglen
Chapter

Abstract

Open reduction and internal fixation is the most appropriate treatment for most adult ambulatory patients with displaced acetabular fractures. However, the outcome is predictably poor in certain fractures in which anatomic reduction and stable fixation cannot reliably be accomplished or maintained due to osteopenia, joint impaction, and comminution. Outcomes are also predictably poor with pre-existing arthritis or femoral head and neck injury. These conditions are commonly seen in older patients, the fastest growing demographic in acetabular fracture. Nonoperative treatment for displaced and unstable fractures in this group often results in unacceptable functional outcomes and morbidity from immobility. Acute total hip replacement is an effective alternative to attempted reconstruction of the articular surface. In most cases, revision prosthetic components are not necessary. Anterior and posterior columns of the pelvis should be stabilized and medial displacement corrected with internal fixation or cabling techniques and bone grafting. Cementless fixation of the prosthetic socket with screws appears to be superior to cemented cups in terms of long-term stability. Stem fixation may be either cemented or cementless depending upon the patient’s needs. Outcomes are not as good as primary hip arthroplasty for arthritis but are superior to open reduction and internal fixation in appropriately selected patients.

Keywords

Acetabulum fracture Acute arthroplasty Combined hip procedure Displaced acetabular fracture Older patient Hip fracture Osteoporotic 

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Jeffrey O. Anglen
    • 1
  1. 1.Hughston Orthopedic TraumaIndianapolisUSA

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