Abstract and Introduction
Posttraumatic arthritis accounts for a notable share of secondary osteoarthritis about the hip joint. Compared with total hip arthroplasty for primary osteoarthritis or inflammatory arthritis, total hip arthroplasty for posttraumatic arthritis offers greater technical challenges because of bone deformities and retained implants. Careful preoperative evaluation is necessary to prepare the approach, hardware removal strategy, and implants necessary to address bone deficiencies. Although arthroplasty is a highly successful procedure for posttraumatic arthritis, the results are less favorable than surgery for primary osteoarthritis. It is associated with a higher incidence of intraoperative and postoperative complications, including periprosthetic fractures, infection, instability, and decreased survivorship.
Total hip arthroplasty is one of the most common joint reconstructive procedures, with over 300,000 being performed yearly in the United States. Over 70% of these are performed for primary osteoarthritis, but it is also an effective treatment for posttraumatic sequelae from prior acetabular or proximal femoral trauma. Various reasons exist for conversion hip arthroplasty including malunion, nonunion, implant failure or cutout, osteonecrosis, and degenerative arthritis (Figure 1). Numerous challenges are uniquely present in patients with arthritis secondary to trauma that are not involved in primary osteoarthritis. Such factors include bone defects, heterotopic ossification, acetabular protrusio, proximal femoral deformity, abductor deficiency, prior infection, and retained implants. Although these reconstructions are more complex, with meticulous planning and surgical technique challenges may be anticipated and mitigated as much as possible.
Radiographs showing reasons for posttraumatic conversion hip arthroplasty. A, Nonunion with implant cutout and resultant acetabular bone defect. B, Malunion with osteonecrosis. C, Degenerative arthritis.
J Am Acad Orthop Surg. 2019;27(8):275-285. © 2019 American Academy of Orthopaedic Surgeons