Delayed Total Hip Replacement for Posttraumatic Arthritis in the Geriatric Patient After Fractured Acetabulum

Geratric patients who are treated operatively or nonoperatively for acetabular fractures may develop posttraumatic arthritis. Performing delayed total hip arthroplasties (THAs) in this patient population may be more technically challenging. Previous operative reports, radiographs, and computed tomography scans may help with preoperative planning. Scarring of the sciatic nerve from previous surgeries may warrant the use of nerve monitoring. Special surgical considerations include choosing a surgical approach, especially through preexisting incisions; deciding whether or not to remove hardware; and removing heterotopic ossification (HO). Multiple fixation options should be available in light of possible acetabular deficiency, including autograft, allograft, structural augments, and acetabular cups offering different fixation options. The postoperative management may differ from primary THAs performed for osteoarthritis because these patients may require protection of weight-bearing status and may require HO prophylaxis. By using the techniques described in this article, delayed THAs after acetabular fractures have demonstrated good outcomes in the geriatric patient population.