Purpose. The ideal timing for a Total Hip Arthroplasty (THA) remains a highly controversial topic in the treatment of displaced acetabular fractures in the elderly with damage to the articular surface of the acetabulum or femoral head. Acute THA offers early rehabilitation but a high incidence of heterotopic ossification has been reported. Its incidence and consequences on the patient's function are not clear. The goal of this study is to compare the incidence of heterotopic ossification following acute THA of acetabular fractures compared to delayed THA, and to evaluate its functional effects on the patient. Method. In this retrospective consecutive case series of acetabular fractures; 20 patients were treated with acute THA and 20 patients were treated with delayed THA after failed conservative or surgical treatment. The incidence of heterotopic ossification (using Brooker's classification) was obtained and functional outcomes were evaluated using SF-12, WOMAC, Harris Hip Score surveys. Results. Heterotopic ossification (HO) was found in 55% (13/20) in the acute THR group compared to 25% (5/20) in the delayed THA group. The relative risk of having significant HO (grades 2–3-4) when the prosthesis was done acutely was 3.4 times higher then when it was delayed. (p=0.01). Furthermore, significant difference in functional outcome was noted in the acute THA group. In fact, seven of eight (7/8) patients in the first subgroup of patients with no HO or grade 1 HO had excellent or good HHS scores. However, only three of eight (3/8) patients with grade 2 or 3 HO showed excellent or good HHS scores. The specific heterotopic ossification grade did not correlate with function. Conclusion. The incidence of HO was significantly higher in patients with acute THA compared to delayed THA for acetabular fractures. Interestingly, in the acute THA group, patients with grades 2 and 3 HO seem to have worst functional outcomes than patients with no HO or grade 1 HO

The aims of the study were primarily to establish the overall success of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) and secondarily to identify risk factors for failure. Using a standardised and recognised study protocol (“Meta-analysis of observational studies in epidemiology (MOOSE) guidelines) a systematic review and meta-analysis of the literature was performed. The primary outcome measure of interest was treatment success. The search strategy and inclusion criteria plus quality assessment yielded 39 articles eligible for analysis. The proportion of success from the literature following DAIR in the management of infected THRs is improving over time – the pooled mean proportion of success is 84.5% in studies from 2011–15. There was improved success with early debridement (75.7%) compared with delayed debridement (48.1%) (p=0.006). The reported outcomes following DAIR appear to be improving with time. One of the most influential determinants of outcome is timing of debridement from onset of symptoms. Surgeons should have a low threshold for investigating deep infection when presented with an acutely symptomatic THR and be aware of the updated reported outcomes associated with DAIR when considering management options