Total hip replacement in complex acetabular fractures using a coned hemipelvic acetabular component.
Acetabular fractures in the elderly are a challenging clinical problem due to both the complex nature of operative intervention, osteoporotic bone and the multiple comorbidities of the patients involved. They are associated with poor functional outcomes and high levels of morbidity and mortality. Treatment currently ranges from conservative treatment, open reduction internal fixation and variations of total hip arthroplasty. We present the surgical technique and early results of the use of a coned hemipelvic acetabular component in the primary treatment of these complex injuries. Five patients (six cases) with a mean age of 75 years have been followed up for 15 months. There were five minor post-operative complications: two patients suffered mild serous wound ooze, two sustained an acute kidney injury, and one a lower respiratory tract infection. One patient suffered pre-operative bilateral sciatic nerve injury, which has partially resolved. There have been no thromboembolic events, dislocations or infections. There have been no cases of prosthesis migration. Four of five patients were able to mobilise fully weight-bearing day one post-operatively, and at latest follow-up four of five mobilised independently with a walking aid. We feel that early weight-bearing mobilisation is essential to achieve a successful outcome in these patients, in a similar way to neck of femur fracture patients. The coned acetabular prosthesis bypasses the fracture, creating an immediately stable construct which allows mobilisation day one post-operatively. The early results of this new technique are promising. Although follow-up is short, there have been no serious complications, a high level of patient satisfaction and radiological evidence of fracture healing, with no prosthesis migration. We aim to continue utilising this technique, with close monitoring of longer-term results.