Surgical Management of Complex and Neglected Hip Injuries Using ArthroplastyBased Reconstruction

Complex acetabular fractures, with or without hip dislocation, in elderly or osteoporotic patients present significant surgical challenges. Traditional open reduction and internal fixation (ORIF) frequently fails in this population due to poor bone quality, fracture comminution, and delayed presentation. This case series describes the use of primary total hip arthroplasty (THA) as an alternative treatment strategy in selected cases. The objective was to evaluate the role of arthroplasty-based reconstruction in the management of complex and neglected hip injuries in the elderly population. This case series includes three patients with neglected or complex acetabular fractures, with or without hip dislocation, managed with primary THA. Surgical approaches, implant selection, and reconstruction techniques were individualised for each case. Clinical presentation, surgical strategy, postoperative rehabilitation, and short-term outcomes were analysed. All patients underwent successful arthroplasty-based reconstruction using appropriate techniques, such as acetabular cages and supplementary fixation when indicated. Early mobilisation was achieved in all cases, with ambulation initiated on postoperative day (POD) 1. All patients were discharged on POD 4. Early functional recovery was achieved in all cases with satisfactory radiological alignment and joint congruity. No perioperative complications or revision surgeries were required. Primary THA with appropriate reconstructive techniques offers a reliable and effective alternative to ORIF in complex and neglected hip injuries, particularly in elderly patients. This approach provides immediate joint stability, enables early mobilisation, and reduces morbidity related to failed fixation and prolonged immobilisation.