Purpose: Twenty-one total hip arthroplasties after ace-tabular fracture were reviewed at a minimum two-year follow-up. The purpose of this analysis was to study operative difficulties and complications in implanting a total hip arthroplasty on a sequelar acetabulum.

Material and methods: Ten acetabula had been treated surgically and eleven orthopaedically. Mean time interval between the initial trauma and the arthroplasty was 14 years (range 2 – 36). The posteriolateral approach was used in thirteen cases and the anterolateral approach in eight. Osteosynthesis material was totally removed in two patients and partially in three. Arthrolysis was performed in one patient who had grade IV heterotopic ossifications. Most of the cups were hydroxyapatite coated uncemented cups; two cups were cemented in a Postel Kerboul ring.

Results: An autologous graft was required for nine of the eleven orthopaedically treated fractures versus two of the ten surgically treated fractures (p < 0 .05). Mean operative time was 136 minutes and mean blood loss was 1200cc. Postoperative complications included one superficial phlebitis, one infraperitoneal bladder wound, one superficial haematoma, one incomplete popliteal palsy, one dislocation and two heterotopic ossiications (1 Brooker I and 1 Brooker IV). At review, the mean Postel Merle d’Aubigné score was 16.5. Radiologically there was no evidence of loosening or defective fixation.

Discussion: The operative difficulty was basically encountered in the group of orthopaedically treated acetabular fractures due to the callus (protrusion of the femroal head into the ovalised acetabulum. For these cases, an autologous graft was indispensable for reconstruction or defect filling (82% of the cases) to avoid excessive medialisation of the cup. For the fractures treated surgically, the osteo-synthesis material was only removed when it prevented proper cup position. An autologous graft was used to fill defects (18%) (wall or roof necrosis). Cup insertion without cement is the rule for first-intention treatment in these young patients, the supporting ring being used when required for second-intention treatment.