Resumo

DEL SEL, Hernán; LOPREITE, Fernando A.; MENUTTI, Marcelo M.  e  MANA, Diego. Total hip arthroplasty after fractures of the acetabulum. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2011, vol.76, n.1, pp.14-19. ISSN 1852-7434.

Background: Fractures of the acetabulum and traumatic hip dislocation can lead to post-traumatic osteoarthritis and femoral head osteonecrosis. Preoperative planning should be done carefully taking into account the technical problems from scar tissue, difficulty in dislocation, persistence of osteosynthesis material and acetabular anatomy. The purpose of this study is to share the results, technical difficulties, and complications in a series of 28 cases. Methods: We retrospectively evaluated 28 patients with hip osteoarthritis (16 patients) or femoral head necrosis (12 patients), secondary to fracture of the acetabulum and traumatic hip dislocation, who underwent total hip arthroplasty. Sixteen were males (57%) and 12 women (44%), with average age of 57 years. The femoral head was used as bone graft in 13 cases. In 10 patients a CT scan was obtained preoperatively. Seventeen cases with previous surgery had the osteosynthesis material in place. Seventeen acetabular cups were cemented, one had a bipolar component, and 10 were uncemented. The femoral component was cemented in 25 cases and uncemented in 3. Results: In 27 patients the average follow-up was 6.3 years. One patient was lost to follow-up at 2 years. No cases of infection were recorded. From a total of 17 cemented cups, 3 loosened (18%). In 10 cases, an uncemented acetabulum was used, with the radiological appearance of highly successful osseointegrated joints. One case suffered two episodes of dislocation. Conclusions: Total hip arthroplasty provides good results in acetabular fracture sequelae. There are greater chances of loosening with cemented cups. An anterolateral approach would be advisable to reduce the incidence of dislocations. The use of patients' femoral head as a bone graft in cases of acetabular defects is an easy and efficient resource.

Palavras-chave : Acetabular fracture sequelae; Total hip arthroplasty.

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