1. THA TO SALVAGE FAILED ACETABULAR FRACTURES
Daniel J. Berry, MD
Mayo Clinic
Rochester, MN

2. THA AFTER ACETABULAR FX Technical Challenges
Acetabular bone loss
Residual pelvic deformity
Nonunited fractures
Retained hardware
Heterotopic ossification
Socket fixation

3. ACETABULAR COMPONENT CHOICE
THA FOR ACETABULAR FX
ACETABULAR COMPONENT CHOICE

4. THA AFTER ACETABULAR FX Previous ORIF
Results: Long Term:
Higher failure rate than THA for OA
Pts young/male/unilateral disease
Uncemented cups better so far than cemented (similar scenario to revision THA)
Weber et al. JBJS 80A(9): , 1998

5. SURVIVAL FREE REVISION FOR ASEPTIC ACET LOOSE/RADIOGRAPHIC LOOSENING Cemented vs Uncemented

6. THA AFTER ACETABULAR FX Acetabular Bone Loss
Socket Fixation:
Apply principles of revision THA (similar sclerotic, deficient bone)
Consensus in North America: Uncemented hemispherical cup

7. THA AFTER ACETABULAR FX Long-Term Socket Fixation: Uncemented Cups
Uncemented Cups: 5 Yr, Data, Rush:
1/30 (4%) revised for loosening
JBJS(A), 2001

8. THA AFTER ACETABULAR FX Long-Term Socket Fixation: Uncemented Cups
Uncemented Cups: Mayo Clinic Data:
34 hips
Minimum F/U 10 yrs (10-16)
Aseptic Loosening 2/34 (6%)
Halasy, Berry, CORR 2002

9. THA AFTER ACETABULAR FX
MANAGEMENT OF BONE LOSS

10. THA AFTER ACETABULAR FX Acetabular Bone Loss
Cavitary Bone Loss: Particulate Graft

11. THA AFTER ACETABULAR FX Acetabular Bone Loss
Segmental Loss: The Posterior/Superior Wall
Use autogenous femoral head graft if needed

13. THA AFTER ACETABULAR FX Acetabular Bone Loss
Results:
Reliable bone graft healing and incorporation

14. THA AFTER ACETABULAR FX
PELVIC DEFORMITY

15. THA AFTER ACETABULAR FX Pelvic Deformity
Landmarks distorted
- care with cup position
Bony prominence
- beware of bone impingement causing instability

16. THA AFTER ACETABULAR FX
NONUNITED FRACTURES

17. THA AFTER ACETABULAR FX Nonunited Fractures
Typically nonunited transverse acetabular fx (pelvic discontinuity)
Stabilize with post column plate

18. THA AFTER ACETABULAR FX Nonunited Fractures
Results:
High rate of fracture healing (100% in personal experience)

19. THA AFTER ACETABULAR FX Nonunited Fractures
Plate Pelvic Discontinuity

20. THA AFTER ACETABULAR FX
RETAINED HARDWARE

21. THA AFTER ACETABULAR FX Retained Hardware
Leave in place if not problematic
Selective removal when needed
Beware of the sciatic nerve

22. THA AFTER ACETABULAR FX Retained Hardware
Selective Hardware Removal

23. THA AFTER ACETABULAR FX Retained Hardware
Selective Hardware Removal

24. THA AFTER ACETABULAR FX Retained Hardware
Sciatic Nerve:
Avoid if possible
If working posteriorly: Identify (beneath g. max. tendon), handle carefully
Do case with knee flexed

25. THA AFTER ACETABULAR FX
HETEROTOPIC BONE

26. THA AFTER ACETABULAR FX Heterotopic Bone
Heterotopic Ossification:
Excise HO if symptomatic
If HO formed after last procedure use prophylaxis (NSAID or radiation) after THA

27. THA AFTER ACETABULAR FX Heterotopic Bone
HO: Excise, Postop Prophylaxis

28. THA AFTER ACETABULAR FX
MINIMIZING COMPLICATIONS

29. THA FOR POSTTRAUMATIC HIP Minimizing Complications
Reducing Complications:
Careful preoperative assessment:
- bone loss
- fracture nonunion
- r/o infection
Know what you are up against

30. THA FOR POSTTRAUMATIC HIP Minimizing Complications
Reducing Complications:
Anticipate more blood loss (cell saver)
Longer operative time
Exposure difficulties (choose based on preference/HO/hardware)

31. THA AFTER ACETABULAR FX Reducing Complications
Anticipate Special Needs (Intra/Postop):
Pelvic reconstruction plates
Autogenous bone grafting
Metal cutting instruments
HO prophylaxis

32. THA AFTER ACETABULAR FX Conclusions
Good planning, careful execution
Modern technology
Usually excellent results despite technical challenges
The patients like these operations--they have a previous failure and you fix it