人工全髋关节置换术后髋臼假体初始不稳定原因分析及处理

目的探讨初次人工全髋关节置换术后髋臼假体初始不稳定的原因及处理方法。方法回顾性分析2003年1月-2010年6月初次人工全髋关节置换术后出现髋臼假体初始不稳定行髋臼翻修术的19例患者临床资料。男11例,女8例;年龄55～79岁,平均67.2岁。左髋9例,右髋10例。应用骨水泥型髋臼假体7例,非骨水泥型12例。初次置换术后3周～6个月行翻修术,平均4.5个月。分析髋臼假体初始不稳定的原因,比较翻修术前后髋臼假体骨覆盖率及髋关节功能Harris评分。结果髋臼假体初始不稳定与髋臼的处理、假体的选择及放置角度、骨水泥操作技术不当等有关。翻修术后l例出现坐骨神经麻痹,7周后自行恢复;1例髋臼前壁轻微骨折,3个月后骨折愈合。术后切口均Ⅰ期愈合,无关节假体周围感染、血管损伤、假体脱位、下肢深静脉血栓形成等并发症发生。术后患者均获随访,随访时间11～73个月,平均28个月。患者均未出现髋臼假体初始不稳定。髋臼假体骨覆盖率由初次置换时的67.9%±5.5%提高至翻修术后87.7%±5.2%,差异有统计学意义(t=11.592,P=0.003)。末次随访时Harris评分为(84.4±4.6)分,较术前的(56.5±9.3)分显著提高(t=11.380,P=0.005)。结论术前详细计划、选择合适的假体、妥善处理髋臼、按合理角度植入髋臼假体有助于获取良好的髋臼假体初始稳定性。     

THA翻修术中髋臼骨缺损的处理策略

目的探讨全髋关节置换术（THA）翻修术中髋臼骨缺损重建的方法及疗效。方法回顾1999年6月至2007年5月,在THA翻修术中处理的髋臼骨缺损112例（117髋）。根据Saleh KJ的改良分型法,Ⅰ型缺损14髋、Ⅱ型缺损26髋、Ⅲ型缺损47髋、Ⅵ型缺损16髋、Ⅴ型缺损14髋。分别采用大直径非骨水泥假体臼、非骨水泥假体臼＋松质颗粒植骨、骨水泥假体臼＋Cage＋松质颗粒植骨和骨水泥假体臼＋定制型假体＋松质颗粒植骨,对不同类型骨缺损进行修复。术后定期随访,采用Harris方法评估髋关节功能,根据X线片判断假体是否有松动,移植骨是否愈合。结果随访时间平均45（13～118）个月。除4髋因脱位或假体周围骨折进行再翻修外,其余效果良好。术后Harris评分平均86.2分,较术前平均改善40.6分。X线片无假体松动下沉,可见移植骨-宿主骨交界处有连续性小梁骨通过。结论在THA翻修术中,大部分髋臼骨缺损可使用较大型号非骨水泥假体或加松质颗粒植骨进行修复;对于影响假体稳定性的较大缺损,使用骨水泥假体臼＋Cage＋松质颗粒植骨的方法可获得良好效果;定制型假体在处理严重髋臼骨缺损中有具独特优势,有良好的临床应用前景。     

初次人工全髋关节置换术中髋臼骨折的原因及处理

目的探讨初次行人工全髋关节置换术(total hip arthroplasty,THA)术中发生髋臼骨折的原因和处理方法。方法 2005年5月-2008年7月,9例9髋初次行THA患者术中发生髋臼骨折。男1例,女8例;年龄41～73岁,平均63.3岁。发育性髋关节发育不良4例,类风湿性关节炎2例,陈旧性股骨颈骨折1例,股骨头缺血性坏死1例,强直性脊柱炎1例。病程1～35年,平均19.5年。左髋3例,右髋6例。Harris评分为(40.4±2.9)分。患者均选择非骨水泥型假体。术中发生髋臼前壁骨折2例,后壁骨折6例,均属稳定型骨折,1例未作特殊处理,余7例给予3～4枚螺钉加强固定;后壁骨折伴后柱不全骨折1例,属不稳定型骨折,给予髋臼杯底植骨联合3枚螺钉固定。结果术后X线片检查示假体位置良好。切口均Ⅰ期愈合,无早期并发症发生。9例患者均获随访,随访时间1～4年,平均2年7个月。末次随访时Harris评分为(87.8±3.9)分,与术前比较差异有统计学意义(t=44.904,P=0.000)。X线片检查示,骨折均于术后8周达临床愈合;随访期间未发现髋臼假体周围透亮带及松动表现。结论初次行THA术前应仔细测量,术中充分显露,精细操作,避免暴力。非骨水泥型髋臼假体直径不应超过髋臼锉直径2 mm;对于骨质疏松患者,宜选用与髋臼锉直径相同的假体并用螺钉固定,或直接采用骨水泥型假体。一旦术中发生髋臼骨折,可根据骨折类型和假体稳定性选用增加螺钉固定或植骨配合多枚螺钉固定。     

Navigation for total hip arthroplasty

Despite increasing advantages in biomaterials, prosthetic designs, and implant fixation, clinical outcome of total hip arthroplasty (THA) has 10% failure rate after 10 years. Component malposition is well known to be responsible for instability, impingement, excessive wear and early loosening. Computer-assisted procedures are expected to improve the accuracy of the components positioning and also the outcome of total hip replacements. We present the Amplivision. system (Amplitude, Porte-du-Grand-Lyon, Neyron, France) that has been used since October 2005 for total hip replacements at our institution. The surgical technique as well as the advantages of this system is described. The Amplivision© system allows accurate positioning of the acetabular and femoral components during THA and also the control of leg lengthening, offset and stability.     

Acetabular component orientation in intra- and postoperative positions in total hip arthroplasty

Introduction  In total hip arthroplasty (THA), acetabular component orientation has critically important effects on dislocation, range of motion, polyethylene wear, pelvic osteolysis, and component migration. The differences in the pelvic orientation in the intraoperative lateral position for insertion of acetabular component during operation and that in the postoperative supine position for evaluation of acetabular component orientation will be one of the factors, which make outliers in acetabular component orientation. We compared acetabular component orientation between intraoperative lateral position and postoperative supine position in 100 consecutive primary THAs. Materials and methods  A total of 100 consecutive primary THAs (between October 2004 and December 2005) in 100 patients performed by a single surgical team were investigated. Intraoperative anteroposterior radiographs of pelvis in the lateral position and postoperative anteroposterior radiographs of pelvis in the supine position were taken. Acetabular component orientation (vertical tilt and anteversion) were measured using computer software. Results  The absolute values of difference between measurements in the two positions were 5.3° ± 4.5° (mean ± SD) for vertical tilt and 5.1° ± 3.7° for anteversion. The difference in the vertical tilt between the two positions was significant (P < 0.0001). Conclusion  The difference in the acetabular component orientation between the two positions, which might be caused by the difference between intra- and postoperative pelvic orientation, should be considered during THA.     

Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

BackgroundIntra-operative fluoroscopy has been shown to improve the accuracy of acetabular component positioning when compared to no fluoroscopy in direct anterior approach (DAA) total hip arthroplasty (THA). Due to logistical reasons, our senior author has been performing DAA THA at one institution without the use of fluoroscopy and has created an intraoperative referencing technique to aid in acetabular component positioning. The purpose of this study is to evaluate the accuracy of acetabular component positioning using fluoroscopy when compared to an intra-operative referencing technique without fluoroscopy.MethodsA total of 214 consecutive primary DAA THA were performed by one surgeon at two institutions and were retrospectively reviewed over a 3-year period. Intra-operative fluoroscopy was used with all patients at Institution A (N = 154). At institution B (N = 60), no fluoroscopy was used, and an intra-operative referencing technique was employed to assist in placement of the acetabular component.ResultsIn the fluoroscopy group, 91% of components met our abduction target, 90% met our anteversion target, and 82.5% simultaneously met both targets. In the non-fluoroscopy group, 98% of components met our abduction target, 92% met our anteversion target, and 90% simultaneously met both targets. There was no difference between groups for placement of the component within both targets simultaneously (p = .171).ConclusionUse of our intra-operative referencing technique is non-inferior in placing acetabular components within a pre-defined safe zone when compared to use of intraoperative fluoroscopy. The intra-operative reference technique can be a helpful adjunct for ensuring accurate acetabular component positioning while simultaneously reducing cost and limiting radiation exposure.     

髋关节发育不良的严重程度与骨水泥型全髋关节置换术后髋臼假体松动的相关性

目的探讨在骨水泥型全髋关节置换术髋臼假体的术后生存率和髋关节发育不良（development dysplasia of the hip,DDH）严重程度的相关性。方法应用骨水泥型全髋关节置换术治疗DDH合并创伤性髋关节炎患者92例103髋,女85例96髋,男7例7髋;年龄39～78岁,平均47．2岁。根据Crowe分级：42例46髋为Ⅰ度,21例24髋为Ⅱ度,16例18髋为Ⅲ度,13例15髋为Ⅳ度。49例56髋采用改良Gibson人路,43例47髋经直接外侧I-Iar-dinge人路。46例48髋使用自体股骨头进行髋臼骨移植,所有移植的骨块均用松质骨螺钉或Kirschner钢丝固定于髋臼上。进行骨移植的适应证主要是髋臼组成部分的上方未取得足够骨覆盖。结果62例76髋获得随访,随访时间2～19年,平均98个月。将因无菌性松脱而行髋臼翻修作为观察终点,10年随访髋臼假体生存率为86．8％～94．4％,平均90．6％;18年随访生存率为53．9％～72．O％,平均63．0％。结论随着髋臼发育不良严重程度的加重,随访年后骨水泥型髋臼假体有更高的失败率。     

Total hip arthroplasty in acetabular fractures

Total Hip Arthroplasty (THA) is a well-accepted treatment for established hip arthritis following acetabular fractures. If a conservatively managed or operated case progresses to non-union/mal-union failing to restore the joint integrity, it may eventually develop secondary arthritis warranting a total hip arthroplasty. Also, in recent years, acute total hip arthroplasty is gaining importance in conditions where the fracture presents with pre-existing hip arthritis, is not amenable to salvage by open reduction and internal fixation, or, a poor prognosis is anticipated following fixation.There are several surgical challenges in performing total hip arthroplasty for acetabular fractures whether acute or delayed. As a separate entity elderly patients pose a distinct challenge due to osteoporosis and need stable fixation for early weight bearing alleviating the risk of any thromboembolic event, pulmonary complications and decubitus ulcer. The aim of surgery is to restore the columns for acetabular component implantation rather than anatomic fixation. Meticulous preoperative planning with radiographs and Computed Tomography (CT) scans, adequate exposure to delineate the fracture pattern, and, availability of an array of all instruments and possible implants as backup are the key points for success. Previous implants if any should be removed only if they are in the way of cup implantation or infected. Press fit uncemented modern porous metal acetabular component with multiple screw options is the preferred implant for majority of cases. However, complex fractures may require major reconstruction with revision THA implants especially when a pelvic discontinuity is present.     

人工全髋关节置换治疗髋臼内陷症的早期疗效

目的探讨人工全髋关节置换治疗髋臼内陷症的方法及早期疗效。方法 2006年1月-2010年2月,收治髋臼内陷症16例16髋。男6例,女10例;年龄39～72岁,平均56.5岁。病程1年6个月～35年,中位病程6.4年。左髋7例,右髋9例。原发性3例,继发性13例。髋关节Harris评分为(49.5±5.5)分。髋臼内陷按Dunlop等的诊断标准分度:轻度3例,中度9例,重度4例。患者均行人工全髋关节置换,髋臼重建时采用植骨及非骨水泥型髋臼假体恢复患髋股骨偏心距及髋臼旋转中心。结果术后16例切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间12～62个月,平均37个月。末次随访时,髋关节Harris评分为(90.5±4.5)分,与术前比较差异有统计学意义(t=49.578,P=0.000)。X线片显示假体位置良好,无松动、下沉,植骨与髋臼融合,无髋臼再次内陷。结论人工全髋关节置换治疗髋臼内陷时,采用植骨及非骨水泥型髋臼假体恢复患髋股骨偏心距及髋臼旋转中心,可获满意早期疗效。     

Total hip arthroplasty in acetabular fractures

Total Hip Arthroplasty (THA) is a well-accepted treatment for established hip arthritis following acetabular fractures. If a conservatively managed or operated case progresses to non-union/mal-union failing to restore the joint integrity, it may eventually develop secondary arthritis warranting a total hip arthroplasty. Also, in recent years, acute total hip arthroplasty is gaining importance in conditions where the fracture presents with pre-existing hip arthritis, is not amenable to salvage by open reduction and internal fixation, or, a poor prognosis is anticipated following fixation.There are several surgical challenges in performing total hip arthroplasty for acetabular fractures whether acute or delayed. As a separate entity elderly patients pose a distinct challenge due to osteoporosis and need stable fixation for early weight bearing alleviating the risk of any thromboembolic event, pulmonary complications and decubitus ulcer. The aim of surgery is to restore the columns for acetabular component implantation rather than anatomic fixation. Meticulous preoperative planning with radiographs and Computed Tomography (CT) scans, adequate exposure to delineate the fracture pattern, and, availability of an array of all instruments and possible implants as backup are the key points for success. Previous implants if any should be removed only if they are in the way of cup implantation or infected. Press fit uncemented modern porous metal acetabular component with multiple screw options is the preferred implant for majority of cases. However, complex fractures may require major reconstruction with revision THA implants especially when a pelvic discontinuity is present.     

Serial measurement of polyethylene wear of well-fixed cementless metal-backed acetabular component in total hip arthroplasty: an over 10 year follow-up study

Serial radiographic measurements of polyethylene wear were performed in 38 hips (33 patients) with primary cementless total hip arthroplasty (THA). The average follow-up period was 131.8 months. All prostheses were assessed as radiographically stable at the latest follow-up. A two-dimensional method was used to calculate the relative migration of the femoral head center to the cup center. The average total linear wear and wear rate were 1.22 mm and 0.11 mm/year, respectively. The degree of wear in the first 2 postoperative years accounted for nearly 40% of the total wear at the end of the study (average follow up: 131.8 +/- 10.0 months, +/-SD). The migration of the femoral head at an average period of 3. 4 months after operation accounted for 56% of the amount of wear in the first 2 years. Wear rate decreased gradually with time and stabilized after the fourth year. However, in 2 patients, a progressive increase in the wear rate was associated with severe osteolysis and failure of THA. Both creep and wear contributed to the femoral penetration into the polyethylene liner. The influence of creep cannot be ruled out, especially in the early period after operation. Polyethylene wear is a multifactorial process, and the study of individual wear patterns might be useful in identifying patients who are at risk of late failure of THA.     

Computed tomographic measurement of acetabular and femoral component version in total hip arthroplasty

Purpose

The purposes of the present study were (1) to investigate the variation and accuracy of both acetabular and femoral component version on the axial computed tomographic (CT) images, and (2) to better define the associations between the components version and clinical factors.

Methods

We investigated acetabular and femoral component orientation in 1,411 primary total hip arthroplasties that had been performed without computer-assisted navigation. Version of the acetabular and femoral components was measured on the axial CT images.

Results

The component version was significantly greater than the native version in both acetabular and femoral version. There was a significant correlation between the stem and native femoral versions, but not between the acetabular component and native acetabular versions.

Conclusion

This study identifies several features that might help analyse the effect of pre-operative native acetabular and femoral version on the variation of component alignment.     

Revision total hip arthroplasty with cemented femoral component

We reviewed retrospectively the results of 28 hips (25 patients) after revision of the femoral component with use of a cemented stem, because of aseptic loosening. The mean duration of follow-up was 4.43 years (range 2–12 years). Over the course of the study period, repeat revision was done in 4 hips after an average of 4.45 years. Three hips had a repeat revision of the femoral component because of aseptic loosening and one for a deep infection. The rate of loosening of the femoral component was 32.4% (9 hips) at an average of 5.22 years. The 5-year survival rate was 76.9% with mechanical failure as end point; and 90% with re-revision of femoral component because of aseptic loosening as end point. The cement mantle was the principal factor, which was significantly associated with a better survival rate of femur fixation (P < 0.05). No correlation was noted between quality of bone loss at the time of revision, bone graft or the use of long stems, and the survival rate of femoral component. By improving the cementing technique and in selected patients, the use of cemented femoral stem could be a good alternative for aseptic loosening THA.     

Outcome of total hip arthroplasty in patients with failed open reduction and internal fixation of acetabular fractures

BackgroundThe problem of failed acetabulum fracture fixation is increasing due to increased incidence of high-velocity injury and a large number of patients are being operated on in the past few years. Limited evidence is available regarding results of Total hip arthroplasty (THA) in patients with failed acetabulum fracture fixation surgery. We assessed the clinical, radiological and postoperative complications. Besides this, we also evaluated functional outcome and quality of life following THA in failed open reduction and internal fixation of acetabular fractures.MethodThe current retrospective study was performed at the tertiary center from 2015 to 2020. Eighteen patients of failed acetabulum fracture fixation surgery (14 males and 4 females) were included with a mean follow-up period of 2.4 years. Postero-lateral approach was done in all cases. Clinico-radiological outcome, functional outcomes were recorded according to Harris Hip score (HHS) and quality of life was assessed by using the 12-Item Short Form Health Survey (SF-12) score. Postoperative complications were also assessed.ResultsThe age of patients ranged from 20 years to 68 years with a mean age of 44.7 years. 16 of the patients (88.9%) had a united acetabular fracture while 2 of them (11.1%) presented with un-united acetabular fracture. The THA implant was found to be stable in all 18 cases. The Harris Hip score of the study ranged from 82 to 95 with a mean of 89.72 ± 4.24 while the SF-12 score ranged from 40.0 to 49.4 with a mean of 44.29 ± 2.95. Out of 18 cases, 11 (61.1%) returned with excellent outcomes while the rest 7 (38.9%) returned with good outcomes as per Harris Hips score criteria. The correlation and regression analysis shows between HHS and SF-12 was positive and statistically significant (r = 0.592, p = 0.010).ConclusionTHA in patients with failed acetabulum fracture fixation surgery provides a reliable option with satisfactory outcomes along with a better quality of life.     

髋关节发育不良患者全髋关节置换术的髋臼中心化

目的 探讨采用全髋关节置换术(THA)治疗髋关节发育不良继发骨关节炎术中髋臼杯假体放置的方法及其对手术疗效的影响。方法 对38例(44髋)于1989年9月至2003年4月接受全髋人工关节置换术的髋关节发育不良继发骨关节炎患者进行了随访。其中男14例,女24例,平均年龄51．2岁(29～80岁),平均随访36．4个月(8～168个月)。按Crowe方法进行分类：Ⅰ型12髋,Ⅱ型24髋,Ⅲ型7髋,Ⅳ型1髋。测量泪滴与髋旋转中心的水平距离并与术后测量结果比较。结果 髋臼杯假体中心化放置者24髋,未加深髋臼者20髋。术后两组Harris评分分别为90．2分、86．3分。结论 对于多数髋关节发育不良患者在行THA时,术中加深髋臼而将髋旋转中心内移和下移,可使髋臼杯假体置于中心化位置得到牢固固定及满意的骨覆盖,术后获得良好的临床疗效。     

髋臼骨折内固定术后继发髋关节深部感染的全髋关节置换术

目的探讨全髋关节置换术（THA）治疗成人髋臼骨折术后继发髋部深部感染的近期临床疗效。方法回顾性分析2009年8月至2012年12月采用THA手术治疗8例成人髋臼骨折术后继发髋部深部感染的临床资料,男5例,女3例;年龄38-51岁,平均45岁。前柱骨折1例,后柱并后壁骨折4例,横行骨折2例,横行伴后壁骨折1例。术前行关节穿刺及术中取关节周围组织送细菌培养和药敏试验。手术取出内固定物,彻底清创,1例行一期THA手术,7例采取一期植入抗生素骨水泥间隔体,术后静脉滴注及口服抗生素,定期复查红细胞沉降率（ESR）、C反应蛋白（CRP）连续两次正常后,行二期THA手术。术后定期随访,常规复查ESR、CRP,摄髋关节正侧位X线片,采用Harris髋关节评分评估髋关节功能。结果所有患者均获得随访,随访时间14-55个月,平均29.5个月。一期与二期手术间隔时间5-15个月,平均8.5个月。Harris髋关节评分从术前平均（53.8±4.9）分,提高至末次随访时平均（92.3±5.3）分,差异有统计学意义（t=33.14,P〈0.01）。随访期间无1例发生假体周围感染、假体松动及脱位。结论对继发于髋臼骨折内固定手术的髋部感染,彻底清创及应用抗生素骨水泥间隔体可有效控制感染,骨小梁金属钽杯可提供有效的骨长入。     

Anatomic placement of the acetabular implant in cementless total hip arthroplasty does not adversely affect the implant survival and patient satisfaction

ObjectiveThis study aimed to evaluate if the acetabulum's conservative reaming with preservation of the medial acetabular bone and anatomic placement of the acetabular implant in cementless total hip arthroplasty (THA) has any adverse effect on the radiological outcome, long term implant survival and patient satisfaction.Methods106 consecutive patients were identified from a single surgeon practice who underwent cementless THA from 2005 to 2010. Twenty-one were lost to follow up, and five patients died unrelated to THA. Eighty patients were available for the study. The mean follow-up was 8.6 years (range 5.7–11.6). The mean age was 61.9 years. Immediate pre- and postoperative radiographs were reviewed to calculate combined offset (Acetabular offset – AO, plus Femoral offset – FO). Implant failure, aseptic loosening, revision surgery, patient satisfaction and complications were assessed on long-term follow-up.ResultsAcetabular component survival was 100% with no aseptic failure. None of the patients had revision surgery for any cause. The mean difference in the acetabular offset and combined offset postoperatively was within 3 mm. One patient had a dislocation, and one had a prosthetic joint infection (PJI). 95% of the patients in this series would recommend the hip replacement procedure to others, with a mean satisfaction score of 8.7 (range; 1–10).ConclusionConservative acetabular reaming with preservation of medial acetabulum bone with the anatomic placement of the acetabular implant in cementless THA is safe with no adverse effects on implant survival and patient satisfaction. It offers the advantage of preserving the patient's bone stock, which would potentially be of significant advantage to the patient and the surgeon in case of revision arthroplasty.     

Pitfalls in the use of acetabular reinforcement rings in total hip revision

Introduction: For the reconstruction of acetabular bone defects different types of acetabular reinforcement rings are being used. In clinical practice, these implants showed to some extent good long-term results. In the present work pitfalls and complications after the implantation of acetabular reinforcement rings as well as possible solutions are being discussed. Material and methods: In the first case recurrent dislocation was caused by the malposition of the acetabular component with an impingement of the protruding bone cement and the anterior edge of the acetabular ring as well as muscle insufficiency as a result of the shortening of the leg length. The second case revealed an impingement of the iliopsoas tendon due to a protruding acetabular reinforcement ring. During revision, bone cement was used to smoothen the protruding anterior edge of the acetabular reconstruction ring in order to obtain a relieved sliding of the tendon. Furthermore, we report on the case of a delayed neuropathy of the sciatic nerve after reconstruction of the acetabulum with an acetabular reinforcement ring. Results: Intraoperatively an impingement of the sciatic nerve at the protruding dorsal edge of the acetabular reinforcement ring and the surrounding scar tissue was found. In a further case an aseptic loosening of an acetabular reinforcement ring caused the formation of an excessive granuloma with a large intrapelvic portion. The granuloma led to persisting senso-motoric deficits of the femoral nerve. In summary, based on these clinical cases possible pitfalls, associated with the use of acetabular reinforcement rings, are shown. The mal-positioning and the intra-operative re-shaping of the implant by the surgeon are pointed out as the substantial factors for the occurrence of an impingement phenomenon and total hip instability. Furthermore, in case of an adequate orientation of the cemented polyethylene insert an improper position of the acetabular ring which results in protruding edges has to be considered as a cause of a prosthetic impingement. Conclusion: The cases presented emphasize the necessity of prevention of such pitfalls intra-operatively as well as accurate analysis of implant failures. Furthermore, they suggest explicit preoperative planning before deciding on the strategy of revision surgery of acetabular reinforcement rings.No benefits or funds were received for this work.     

Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures

BackgroundPost traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures.MethodsWe included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1–14.1) years after an operatively treated acetabular fracture. The median age was 54 (11–82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years.ResultsTen-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre.ConclusionTotal hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present.