Strategies of management of traumatic periprosthetic acetabular fractures around a pre-existing total hip arthroplasty

Introduction: and aim: Traumatic peri-prosthetic fractures are relatively rare fractures that pose a significant surgical challenge. They have a fracture pattern that is different from its iatrogenic counterpart. This study aimed at reviewing the modalities of treatment of such injuries, proposing a treatment algorithm and reporting the outcomes of these injuries.

Patients and methods: We propose an algorithm for management of traumatic peri-prosthetic acetabular fractures which depends on fracture displacement, implant stability and associated bone loss.Twelve patients with traumatic peri-prosthetic acetabular fractures were treated between January 2012 and December 2018. All patients were treated surgically. Patients were allowed immediate weight bearing as pain allowed. Assessment was carried out using the Oxford Hip Score (OHS) and the Merle D'aubigné score (MDP).

Results: Mean patient age 71 (range: 59-80). 8 patients underwent implant removal, fracture fixation and re-implantation of revision acetabular cup (displaced fracture, unstable implant, adequate bone stock). Three patients required acetabular reconstruction (inadequate bone stock). One patient underwent revision acetabular component. One patient suffered from recurrent dislocation that required surgical intervention. Mean follow up was 27 Months (range 12-48). Mean OHS was 36 (range 10-47). Mean MDP was 12 (range 9-18) with 80% excellent and good results.

Conclusion: Surgical management of peri-prosthetic acetabular fractures can produce good to excellent results provided adequate assessment and surgical planning have been carried out. Fracture displacement, implant stability and bone stock should be carefully assessed.