European Journal of Orthopaedic Surgery & Traumatology
ORIGINAL ARTICLE • HIP - ARTHROPLASTY
Functional outcome of acute primary total hip replacement
after complex acetabular fractures
· Asmat Ullah
· Sajid Younus
· Akram Aliuddin
· Osama Bin Zia
· Naveed Khan
Received: 9 February 2018 / Accepted: 15 May 2018
© Springer-Verlag France SAS, part of Springer Nature 2018
Purpose To assess the functional outcome of acute primary total hip replacement in the management of complex acetabular
Materials and methods This prospective observational study was conducted in orthopedic department of Liaquat National
Hospital and Medical College, Karachi. The study was approved by the Ethics review committee of hospital (0190-2016).
Patients who encountered between January 2010 to January 2016 were entered. Fifty-four patients with acetabular fractures
with certain indications (marginal impaction or signiﬁcant comminution (> 3 fragments) of the articular surface of the
acetabulum, full-thickness articular injury to the femoral head, an associated femur neck fracture, or preexisting sympto-
matic osteoarthritis) were treated with primary total hip replacement. Patients were followed in outpatient clinic at regular
intervals after discharge to assess the radiological union of fractures and complications. Functional outcome was evaluated
after 2 years by applying Harris Hip Score. All statistical analysis was done by using SPSS version 20.
Results All patients achieved radiological union of fractures at an average duration of 21 weeks. During the follow-up, seven
complications were observed. Two patients developed superﬁcial surgical site infection which was treated conservatively.
One patient had dislocation which was reduced closely, while two patients had acetabular cup loosening which was revised.
We also observed two cases of Brooker I heterotopic ossiﬁcation and one case of Brooker II. At 2-year follow-up, 78% of
patients had an excellent and good functional outcome according to Harris Hip score.
Conclusion Primary total hip replacement is a valid and reasonable one stage surgical treatment of complex acetabular
fractures and in aged individuals. However, the complications are not uncommon.
Keywords Acetabulum · Acetabular fractures · Acetabular reconstruction · Total hip replacement
Acetabular fractures are complex fractures with a ris-
ing trend in developing countries. This might be due to
increase in motor vehicle accidents [1, 2]. Fractures of
the acetabulum typically occur in young, healthy adults
from high-energy trauma like a motor vehicle accident
or a fall from height. By contrast, geriatric patients may
sustain an acetabular fracture from a simple fall due to
the brittleness of osteoporotic bone . Currently, open
reduction and internal ﬁxation (ORIF) are the standard
treatment for displaced acetabular fractures. However,
there are certain complex acetabular fractures which has
poor functional outcome despite good internal ﬁxation.
These fractures are what Mears describes as fractures
with an intrinsically abysmal outcome . Functional
outcome after open reduction and internal fixation of
* Faizan Iqbal
Osama Bin Zia
Department of Orthopaedic Surgery, Liaquat National
Hospital, Karachi, Pakistan