Primary Total hip arthroplasty for acetabular fractures in elderly: a review of the literature

Abstract

Acetabular fractures are severe injuries which commonly present in young adults after high-energy trauma, usually secondary to road traffic collisions. During such incidents, the femoral head may be driven into the acetabulum leading to both bony and neurovascular injuries. Open reduction and internal fixation is considered the gold standard of treatment for displaced fractures, while non-displaced or minimally displaced (b2 mm) fractures can be treated with non-operative methods with satisfactory results. Restoration of congruency of the joint plays an important role in treatment outcome, although development of post-traumatic osteoarthritis can occur even after anatomical reconstruction. Contrary to young adults, in the elderly population, low-energy trauma is responsible for a high percentage of acetabular fractures, due to the frequency of falls and increased prevalence of osteopenia and osteoporosis. Several authors have reported that open reduction and internal fixation in the elderly patients is associated with poor prognosis and higher rate of long-term complications. Consequently, the role of primary total hip arthroplasty in combination with surgical reconstruction of the acetabular fracture has lately attracted an increased interest with clearly defined indications and promising results. On the other hand, regardless of the timing of intervention, complications of total