Neglected posterior acetabular wall fracture managed with uncemented total hip arthroplasty with posterior wall reconstruction by femoral head autograft: a case report

Abstract

Total hip arthroplasty (THA) poses several challenges as a treatment option for acetabular fracture especially in the setting of a neglected fracture. The potential technical challenges of THA include the altered anatomy and hip centre, acetabular bone deficit, difficulty in achieving long-term fixation of the acetabular shell and risk of nerve injury. In our case, a forty two years old, male labrourer presented with a five months old injury, which was previously managed only conservatively. Preoperative evaluation revealed displaced posterior wall acetabulum with superiorly migrated femur head with flattened contour. We managed the case with uncemented THA. The acetabular defect was addressed using the femoral head autograft which was secured with screws. On three months follow up, radiographical evalution showed good graft consolidation without any acetabular component migration and functionally a Harris hip score of 76. Thus, in case of neglected acetabular fractures, with high probability of post traumatic arthritis to develop, THA remains the preferred choice of management. Albeit challenging to perform, THA provides effective way to decrease pain, improve stability and increase functional outcomes.