Acetabular fractures converted to total hip arthroplasties in the elderly: how does function compare to primary total hip arthroplasty?

OBJECTIVES

Little data exist regarding the outcomes of total hip arthroplasty (THA) after acetabular fracture treatment failure. We hypothesize that these patients achieve a lower level of function than those who undergo primary THA for osteoarthritis (atraumatic).

DESIGN

Retrospective review. Control group consisted of sequential patients who underwent a primary THA for osteoarthritis and were 60 years or older at the time of surgery.

SETTING

Level I Academic Trauma Center.

PATIENTS: One hundred seventy-one patients older than 60 years when they sustained an acetabular fracture were included in this study. Seventeen (10%) patients were converted to THA. Control patients were treated with primary THA for osteoarthritis.

MAIN OUTCOME MEASURES: Musculoskeletal function assessment scores and Harris Hip scores were obtained after a minimum follow-up of 2 years.

RESULTS

Thirteen patients underwent open reduction and internal fixation, 3 underwent nonoperative treatment, and 1 received an acute THA. The most common fracture patterns converted to THA were associated both column (n = 5) and posterior column with posterior wall (n = 5). The average time to conversion to THA was 35 months. When compared with controls, patients who had THA after an acetabular fracture had significantly higher Musculoskeletal Function Assessment scores and significantly lower Harris Hip scores, indicating worse level of function.

CONCLUSIONS

Patients who undergo THA after acetabular fracture have significantly worse functional outcome scores when compared with patients who undergo a primary THA for osteoarthritis.

LEVEL OF EVIDENCE: Prognostic level III.