title: Delayed Total Hip Arthroplasty for Failed Acetabular Fractures: The Influence of Initial Fracture Management on Outcome After Arthroplasty.
abstract: Total hip arthroplasty (THA) provides a successful salvage option for failed acetabular fractures. The complexity of arthroplasty for a failed acetabular fracture will depend on the fracture pattern and the initial management of the fracture. Our objective was to compare the midterm outcome of THA between patients who presented with failed acetabular fractures following initial surgical or nonsurgical treatment.
  
  
  
  Forty-seven patients underwent cementless THA ± acetabular reconstruction following failed treatment of acetabular fractures. Twenty-seven were initially treated by surgery (group A) and 20 had nonsurgical treatment (group B). Intraoperative measures, preoperative and follow-up clinical, radiological, and functional outcomes were compared between the 2 groups.
  
  
  
  The mean surgical time, blood loss, and need for blood transfusion were significantly less in group A (P < .05). Acetabular reconstruction to address cavitary or segmental defects was needed in a significantly higher number of patients in group B (P = .006). Significant improvement in modified Merle d'Aubigne and Oxford scores was seen postsurgery in both groups. Acetabular component survival with aseptic loosening as end point was 98%. Overall survival rate with infection, revision, or loosening as end point was 93% at a mean follow-up of 7 years ± 17 months.
  
  
  
  THA for a failed acetabular fracture is greatly facilitated by initial surgical treatment. Although functional results and survivorship were similar in both groups, failed nonsurgical treatment in complex fractures is associated with migrated femoral head and extensive acetabular defects requiring complex acetabular reconstruction.
authors: Department of Orthopedics, Parvathy Hospital, Chennai, India.
authors: Ashok S
authors: AS
authors: Gavaskar
authors: Department of Orthopedics, MOSC Medical College, Cochin, India.
authors: Hitesh
authors: H
authors: Gopalan
authors: Department of Orthopedics, Sri Ramachandra Medical College, Chennai, India.
authors: Bhupesh
authors: B
authors: Karthik
authors: Department of Orthopedics, Dr. Metha's Hospital, Chennai, India.
authors: Parthasarathy
authors: P
authors: Srinivasan
authors: Department of Orthopedics, Swaram Hospital, Chennai, India.
authors: Naveen C
authors: NC
authors: Tummala
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D025981:Hip Injuries / Q000601:surgery; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome
keywords: acetabular defects; acetabular fractures; acetabular reconstruction; bone grafting; cementless total hip arthroplasty; delayed total hip arthroplasty