Total Hip Arthroplasty for Posttraumatic Conditions

Min Lu, MD; Dayna Phillips, MD

J Am Acad Orthop Surg. 2019;27(8):275-285.

Summary

Posttraumatic conversion hip arthroplasty is associated with greater rates of intraoperative and postoperative complications compared with primary total hip arthroplasty. With meticulous patient selection, workup, and preoperative planning, many challenges can be anticipated and risks mitigated to achieve a satisfactory result.

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Table 1. Results of Conversion Arthroplasty for Prior Acetabular Trauma
Study	Number of Hips	Mean Age (yr)	Mean Follow-up (yr)	Survivorship	Complications
Romness and Lewallen²⁰	55	56	7.5	82% at 10 yr	Patients younger than 60 yr had 17.2% incidence of revision, >60 yr had 7.7% revision rate
Weber et al²¹	66	52	9.6	78% at 10 yr	Age <50 yr, weight ≥ 80 kg, large residual acetabular bone defects were notable risk factors for aseptic loosening
Bellabarba et al²²	30	51	5.3	97% at 10 yr	Surgical time, blood loss, transfusion requirements greater in patients with posttraumatic arthritis than in nontraumatic arthritis, and greater in those treated with ORIF than in those treated closed
Ranawat et al²³	32	52	4.7	79% at 5 yr	Need for revision correlated with nonanatomic hip center and history of infection
von Roth et al²⁴	25	52	20	57% at 20 yr	11 revisions for aseptic loosening, 7 for osteolysis, 1 for instability
Yuan et al²⁵	30	45	5	88% at 5 yr	3 deep infections, 2 dislocations, 7 Brooker class III or IV heterotopic ossification
Morison et al²⁶	74	51	8	70% at 10 yr	14 aseptic loosening, 6 wear, 2 infection, 1 femoral fracture, 1 instability

ORIF = open reduction and internal fixation

Table 2. Results of Conversion Arthroplasty for Prior Proximal Femoral Trauma
Study	No. of Hips	Mean Age (yr)	Mean Follow-up (yr)	Survival	Complications
Haidukewych and Berry²⁷	60	78	5	87.5% at 10 yr	5 revision surgeries: 1 aseptic loosening, 1 osteolysis, 1 trochanteric nonunion, 1 symptomatic trochanteric implant, 1 hematoma
McKinley and Robinson²⁸	99	73	7.4	66.7% at 10 yr	8 deep infections, 14 revisions for dislocation, 3 periprosthetic fractures, 8 aseptic loosening
Mabry et al²⁹	84	68	12.2	76% at 20 yr	10 aseptic loosening, 9 dislocation
Mortazavi et al³⁰	120	70	4.5	NR	9 patients with infections, 1 heterotopic ossification requiring surgery, 4 other revisions
Archibeck et al³¹	102	70	3.2	93.2%	5 dislocations, 4 periprosthetic fractures, 2 hematomas, 1 infection
DeHaan et al³²	46	64	0.7	87%	4 intraoperative fractures, 3 dislocations, 3 deep infections, 1 superficial infection
Pui et al³³	91	65	3	SHS: 88.3%; CMN: 58.1%	5 orthopaedic complications in the SHS group, compared with 10 in the CMN group
Hernandez et al³⁴	62	78	5.5	97% at 5 yr	1 femoral aseptic loosening, 3 infections