Total hip replacement for neglected acetabular fractures

Purpose Neglected acetabular fracture can be approached by different surgical methods, but the optimal treatment is represented by total hip replacement (THR), which theoretically should ensure a stable, painless hip, with almost-normal mobility and a hope of survival as long as possible. This study aims to evaluate the outcomes of THR in patients with neglected acetabular fractures. Methods By analyzing clinical and radiological outcomes, surgical challenges, and complication rates, we aim to provide insights into the efficacy and limitations of this approach. This is a retrospective study, 8 patients who underwent THR for neglected acetabular fractures between 2020 and 2024. All patients were assessed at 6 weeks, 6 months, 1 year and 2 years after surgery. Results As expected, regardless of the fracture type and the interval between initial trauma and index procedure, Harris hip score showed continuous improvement in successive examinations at 3, 6, 12, and 24 months; younger patients had the best preoperative scores and the fastest postoperative progression. The lowest preoperative score and the lowest rate of improvement was observed in elderly patients. The results of our case series suggest that THR might be an effective treatment for neglected acetabular fractures. The critical challenge is how to approach the acetabular defect to obtain a stable hip. Conclusions Neglected fractures are more difficult to repair and have poorer surgical outcomes. Successful outcomes are expected if a solid bone stock is achieved using various surgical techniques.