Total hip arthroplasty for acute acetabular fractures through the replace-in-situ philosophy

Aims This study investigated the outcomes of total hip arthroplasty (THA) performed for acute acetabular fractures through a replace-in-situ technique, where no attempt was made at fracture reduction, fixation, or restoration of columns before acetabular component insertion. Methods We report the clinical outcomes at a mean follow-up of five years of 41 acute complex acetabular fractures in 41 patients, with a mean age of 76 years (54 to 97), who underwent THA through a replace-in-situ technique. Results Four patients died during the acute episode of care, and one within 12 months. All fractures healed within six months and all patients who survived the acute episode of care returned to their baseline function. A total of four patients underwent further surgery: one underwent revision for cup loosening at 18 months, one underwent open reduction and internal fixation of a femoral periprosthetic fracture at seven years, and two underwent head-liner exchange at two and four months for recurrent dislocation. One additional cup was radiologically loose but not revised, as this caused no additional symptoms. Conclusion THA using a replace-in-situ technique shows promising results comparable to those reported for fix-and-replace techniques. As clinical outcomes continue to be inferior to those of THA for osteoarthritis, larger multicentre studies are required to investigate possible differences between surgical indications and techniques. Cite this article: Bone Joint J 2025;107-B(8):784–792.