Neglected posterior acetabular wall fracture managed with uncemented total hip arthroplasty with posterior wall reconstruction by femoral head autograft: a case report

Abstract

<p class="abstract">Total hip arthroplasty (THA) poses several challenges as a treatment option for acetabular fracture especially in the setting of a neglected fracture. The potential technical challenges of THA include the altered anatomy and hip centre, acetabular bone deficit, difficulty in achieving long-term fixation of the acetabular shell and risk of nerve injury. In our case, a forty two years old, male labrourer presented with a five months old injury, which was previously managed only conservatively. Preoperative evaluation revealed displaced posterior wall acetabulum with superiorly migrated femur head with flattened contour. We managed the case with uncemented THA. The acetabular defect was addressed using the femoral head autograft which was secured with screws. On three months follow up, radiographical evalution showed good graft consolidation without any acetabular component migration and functionally a Harris hip score of 76. Thus, in case of neglected acetabular fractures, with high probability of post traumatic arthritis to develop, THA remains the preferred choice of management. Albeit challenging to perform, THA provides effective way to decrease pain, improve stability and increase functional outcomes<strong>.</strong></p>

Functional outcome after total hip replacement following 30 years neglected posterior hip dislocation: a rare case report

“…2,6 This procedure also remains a preferred option in case of neglected acetabular fractures with high risk of secondary post-traumatic arthritis. 7 In general, total hip replacement is a surgical procedure with a number of surgical approaches exist, each has unique advantages and disadvantages. The well-known approaches include the direct anterior, direct lateral, and posterior approach.…”

Restoring stability in a neglected acetabular fracture with dual mobility total hip arthroplasty: a case report

“…8,10 A similar case report by Avtar et al, highlights the use of femoral head autograft fixed with screws and an uncemented THA following a neglected acetabular fracture. 3 We managed our case with the same principles of recreating the deficient bone and providing additional stability using a cage and a DM THA. DM THA has been shown to be specifically indicated in cases with loss of abductor mechanism, compromised soft tissues, bone loss; whereby it reduces the dislocation rates by increasing the jump distance and thus leads to additional stability.…”

“…1 More so, these cases have a higher chance of post-operative dislocation, heterotrophic ossification and higher revision rates. [1][2][3] Computed tomography (CT scan) and 3D reconstruction plays a big role in preoperative analysing and planning of the acetabular and peri acetabular bony defects. 4 The advent of dual mobility (DM) THA has provided a new design which biomechanically reduces dislocation rates, especially so with compromised bony and/ or soft tissue conditions.…”