Acetabular Fracture Following Total Hip Replacement in a Patient With Neglected Developmental Dysplasia of the Hip: A Case Report.

Neglected DDH can cause degenerative changes to the hip joint that could result in subsequent hip pain and disability. The best treatment for these patients is total hip arthroplasty (THA) with artificial joint prosthesis implantation. Acetabular fractures in dysplastic hips with THA are uniquely complex, being more unstable, difficult to assess radiographically due to implant interference, and often atypical in pattern. Management is highly challenging, as treatment decisions must balance surgical risks with prosthetic stability and patient factors, making the successful conservative recovery in this case both rare and notable. This case report presents a case of a 42-year-old female patient with neglected DDH who underwent bilateral total hip replacement complicated by a spontaneous acetabular fracture. Radiographs revealed a nondisplaced, spontaneous acetabular fracture in the superior region. Based on the timing and implant stability, the injury was classified as a Pascarella Type 2A. Due to the clinical context and surgical complexity in dysplastic hips with prior THA, the patient was treated conservatively consisting of protected weight-bearing, rehabilitation, and close follow-up, with full improvement.