66 primary total hip arthroplasties were performed to treat post-traumatic osteoarthrosis that had developed following an acetabular fracture and subsequent open reduction and internal fixation. The mean age of the patients at the time of the total hip arthroplasty was 52 years (range, 19 to 80 years). The arthroplasty was performed with cement in 44 hips and without cement in 20 hips; in the remaining 2 hips, the acetabular component was inserted without cement and the femoral component was inserted with cement (a so-called hybrid procedure). Scarring from a previous procedure, retained hardware, heterotopic bone, and residual osseous deformity and deficiency made the procedure more complex than routine total hip arthroplasty in most patients. However, only one of the 66 procedures was associated with an operative complication. 3 patients were lost to follow-up. The remaining 63 patients were followed for a mean of 9.6 years (range, 2 to 20 years). The mean duration of follow-up was 14.9 years for the acetabular components inserted with cement, 11.6 years for the femoral components inserted with cement, 4.6 years for the femoral components inserted without cement, and 3.9 years for the acetabular components inserted without cement. The mean Harris hip score improved from 49 points preoperatively to 93 points at the latest follow-up evaluation for the 46 patients who did not have a revision procedure after the index arthroplasty. 17 patients had a revision; 16 revisions were performed because of aseptic loosening of one or both components (9 acetabular and 11 femoral components). Mechanical failure (radiographic loosening or revision due to aseptic loosening) occurred in 25 hips. As determined with use of the Kaplan-Meier method, the 10-year survival rate, with revision due to aseptic loosening as the end point, was 78 per cent (95 per cent confidence interval, 66 to 92 per cent) for the prosthesis as a whole (that is, no revision of either component), 87 per cent (95 per cent confidence interval, 76 to 99 per cent) for the acetabular component, and 84 per cent (95 per cent confidence interval, 72 to 97 per cent) for the femoral component. An age of less than 50 years (p = 0.02), a weight of 80 kilograms or more (p = 0.047), and large residual combined segmental and cavitary deficiencies in the acetabular bone (p < 0.0001) were significant risk factors for revision because of aseptic loosening. At the 10-year follow-up, none of the 22 acetabular components that had been inserted without cement had been revised or demonstrated radiographic loosening. The 10-year rate of failure due to aseptic loosening was higher than that in many reported series of total hip arthroplasties performed for other indications; this was probably partly because of the young mean age of the patients, the high number of patients who had Charnley class-A involvement, and the predominantly male cohort.
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66 primary total hip arthroplasties were performed to treat post-traumatic osteoarthrosis that had developed following an acetabular fracture and subsequent open reduction and internal fixation. The mean age of the patients at the time of the total hip arthroplasty was 52 years (range, 19 to 80 years). The arthroplasty was performed with cement in 44 hips and without cement in 20 hips; in the remaining 2 hips, the acetabular component was inserted without cement and the femoral component was inserted with cement (a so-called hybrid procedure). Scarring from a previous procedure, retained hardware, heterotopic bone, and residual osseous deformity and deficiency made the procedure more complex than routine total hip arthroplasty in most patients. However, only one of the 66 procedures was associated with an operative complication. 3 patients were lost to follow-up. The remaining 63 patients were followed for a mean of 9.6 years (range, 2 to 20 years). The mean duration of follow-up was 14.9 years for the acetabular components inserted with cement, 11.6 years for the femoral components inserted with cement, 4.6 years for the femoral components inserted without cement, and 3.9 years for the acetabular components inserted without cement. The mean Harris hip score improved from 49 points preoperatively to 93 points at the latest follow-up evaluation for the 46 patients who did not have a revision procedure after the index arthroplasty. 17 patients had a revision; 16 revisions were performed because of aseptic loosening of one or both components (9 acetabular and 11 femoral components). Mechanical failure (radiographic loosening or revision due to aseptic loosening) occurred in 25 hips. As determined with use of the Kaplan-Meier method, the 10-year survival rate, with revision due to aseptic loosening as the end point, was 78 per cent (95 per cent confidence interval, 66 to 92 per cent) for the prosthesis as a whole (that is, no revision of either component), 87 per cent (95 per cent confidence interval, 76 to 99 per cent) for the acetabular component, and 84 per cent (95 per cent confidence interval, 72 to 97 per cent) for the femoral component. An age of less than 50 years (p = 0.02), a weight of 80 kilograms or more (p = 0.047), and large residual combined segmental and cavitary deficiencies in the acetabular bone (p < 0.0001) were significant risk factors for revision because of aseptic loosening. At the 10-year follow-up, none of the 22 acetabular components that had been inserted without cement had been revised or demonstrated radiographic loosening. The 10-year rate of failure due to aseptic loosening was higher than that in many reported series of total hip arthroplasties performed for other indications; this was probably partly because of the young mean age of the patients, the high number of patients who had Charnley class-A involvement, and the predominantly male cohort.
Copyright remains with the authors and publisher.