Cementless acetabular reconstruction after acetabular fracture

Background: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthr itis. The use of cementless acetabular reconstruction, however, has not bee n extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless a cetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compare d the results of arthroplasty in patients who had had prior operative treat ment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture. Methods: Thirty total hip arthroplasties were performed with use of a cemen tless hemispheric, fiber-metal-mesh-coated acetabular component for the tre atment of posttraumatic osteoarthritis after acetabular fracture. The media n interval between the fracture and the arthroplasty was thirty-seven month s (range, eight to 444 months). The average age at the time of the arthropl asty was fifty-one years (range, twenty-six to eighty-six years), and the a verage duration of follow-up was sixty-three months (range, twenty-four to 140 months). Fifteen patients had had prior open reduction and internal fix ation of their acetabular fracture (open-reduction group), and fifteen pati ents had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthropl asties with cementless acetabular reconstruction in patients with nontrauma tic arthritis. Results: Operative time (p < 0.001), blood loss (p < 0.001), and perioperat ive transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic ar thritis. Of the patients with posttraumatic arthritis, those who had had op en reduction and internal fixation of their acetabular fracture had a signi ficantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fr acture had been treated by closed,methods. Eight of the fifteen patients wi th a previous open reduction and internal fixation required an elevated ace tabular liner compared with one of the fifteen patients who had been treate d by closed means (p = 0.005). Two of the fifteen patients with a previous open reduction and internal fixation required bone-grafting of acetabular d efects compared with seven of the fifteen patients treated by closed means (p = 0.04). The thirty patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 p oints at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39). Twenty-seven pa tients (90%) had a good or excellent result. There were no dislocations or deep infections. The Kaplan-Meier ten-year survival rate, with revision or radiographic loosening as the end point, was 97%. These results were simila r to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis. Conclusions: The intermediate-term clinical results of total hip arthroplas ty with cementless acetabular reconstruction for posttraumatic osteoarthrit is after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especia lly in patients with previous open reduction and internal fixation. Previou s open reduction and internal fixation predisposed the hip to more intraope rative instability but less bone deficiency.