Post acetabular fracture situation with a deranged hip is a challenging condition for the surgeon.
When one has a congruent hip , it is best that an anatomical reconstruction is done and graft to be avoided as shown in the example here. A graft from the femoral head is required only when there in post wall deficiency and incongruity of the hip.
If the head of the femur is not congruent and has migrated proximal it denotes acetabular insufficiency.
In this situation it is technically incorrect to put a standard THR – unfortunately a mistake commonly made!. When instability is present one has to do a bone grafting with the femoral head and then do a Hip Replacement on top of it.
In this example there is dislocation of the hip but the pos t column is intact. This is best managed with a femoral head autograft. Excellent stability and cover can be achieved. The head will match the post wall defect accurately. The techniique of using femoral head autograft where provisional fixation is done only with K-wires so that the cup gets primary press fit in the acetabular has been developed by Dr. Bose. This can be seen in the video
Femoral head autograft is rqd for this patient as one can see the subluxtion of the hip . In our unit we prefer using delta ceramic on delta ceramic bearing as acetabular fracture typically occur in young active patients.
Here one can make out the post wall defect with the resultant post dislocation of the femoral head. This hip is reconstructed with the femoral head autograft.
If the patient is very young and active another alternative is to reconstruct the hip with the BHR dysplaia cup. Here bolts going till the sacro-iliac joint takes the place of the bone graft.
If the post column is not continuous it is critical that the post column is s stabilised with a plate before any form o hip reconstruction is done. If not then the cup will fail early. This is again a common mistake made frequently by surgeons.