Conversion Total Hip Arthroplasty with a Direct Anterior Approach for Failed Treatment of Acetabular Fractures

Abstract

Total hip arthroplasty (THA) is a salvage procedure after failed treatment of acetabular fractures. Technical challenges increase the risk of perioperative complications, specifically nerve palsy and dislocation. The direct anterior approach (DAA) was evaluated to mitigate these risks. Clinical and radiographic outcomes were reviewed retrospectively. Thirteen patients underwent conversion THA. Of the 13, nine had been treated with open reduction internal fixation (ORIF), one with traction, and three conservatively. When possible, retained hardware was deliberately left in place. At a mean follow-up of 4 years, there were no major complications, readmissions, revisions, or deaths. Two nonunions managed with autografting went on to union. The mean HOOS (hip disability and osteoarthritis outcome) Jr score at follow-up was 89. These data suggest that the DAA may be a reasonable alternative to the posterior approach in this high-risk population.

Keywords

acetabular fracture - total hip arthroplasty - direct anterior approach - nerve palsy - dislocation

Publication History

Received: 31 March 2020

Accepted: 26 May 2020

Article published online:
22 September 2020

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