Total hip arthroplasty after acetabular fracture: does initial treatment make any difference to the outcome? A 5- to 23-year follow-up with clinical and radiological analysis.

Purpose: To determine if initial treatment affects the outcome of total hip arthroplasty (THA) after acetabular fracture. Methods: 49 patients (49 hips) initially treated non-operatively followed some months later by THA in conjunction with acetabular reconstruction (Group 1) and 29 patients (29 hips) who had undergone THA after a previous osteosynthesis (Group 2) were assessed. The mean follow-up was 11.7 (range 5-23) years. Results: 3 acetabular components were revised for aseptic loosening in Group 1 and 2 in Group 2. The survival rate for cup loosening at 16 years was 90.6% (95% confidence interval [CI], 78.1-100) for Group 1 and 94.1% (95% CI, 86.5-100) for Group 2 (p = 0.76). There were 2 sciatic palsies in Group 2 after osteosynthesis. The mean preoperative clinical score and postoperative range of mobility were better in Group 1. There were more heterotopic ossifications in Group 2. Conclusion: Despite the good results found in both groups, THA after previous osteosynthesis for acetabular fractures had more complications than a primary THA in conjunction with acetabular reconstruction.