IAFs are a rare complication of the primary THA. therefore it has been difficult to accumulate a cohort large enough to study this problem. However the incidence of IAFs has gradually increased in recent years [4, 7, 8]. Multiple clinical studies have suggested that uncemented THA’s are at a higher risk of acetabular fracture compared to their cemented counterparts .[5, 12, 13]With the wide use of uncemented acetabular components, as an joint surgeon will undoubtedly encounter IAFs in his surgical career. In this article, the fracture rate associated with uncemented components was 0.49%, which is close to the 0.4% that the rate of fracture around the acetabular components when the uncemented acetabular components is implanted, as reported by Haidukewych and colleagues. We introduces the treatment of our institution when encountering these problems. Methods and their prognosis.
Jonathon and colleagues found that 2 patients with post-invasion posterior column were found by postoperative X-rays, and revision surgery was performed within 3 months; 1 patient was found intraoperatively with internal fixation, and the follow-up effect was good. In this series of our studies, the fracture of the posterior column occurred in patient5. During the operation, it was found that the internal fixation with steel plate and screws was performed. The follow-up effect was good after 4 years of operation, which verified this. Fractures occurring in the column should be found and treated in time.
The main difficulty in IAFs is to find it, estimate its level and obtain the stability of an effective acetabular components to minimize the risk of aseptic loosening. According to some authors, cable fixation can be used[15, 16]and internal fixation plates and screwsfor adequate acetabular components stability. Tidemark and colleagues  found the use of strengthening plates in the presence of acetabular components fractures. However, in this cohort study, 23 patients found IAFs during operation, and were given timely screw internal fixation or plate and screws. Internal fixation and prognostic are good. The strengthening ring seems to provide better stability, but there is no significant difference in the prognosis or the incidence of complications between patients who use the screw alone and the combination of the strengthening ring and the screw. Haidukewych and colleaguesfound that 21 patients with acetabular fractures were identified during the operation. All patients were identified for at least 2 years of follow-up or revision surgery. The results showed that all patients had good fracture healing except for 2 patients who were lost to follow-up. Complications occurred and bone growth was good. Our institution's research verified this. For the IAFs found during the operation, the stability of the acetabular component was determined by screws or internal fixation plates, and timely treated during the operation. The prognosis is relatively good.
Patient 20 had an autologous femoral head grafting to reconstruct the acetabulum, and the patient's prognosis was good. In a cohort study of Sharkey and colleagues, 4 patients underwent autologous bone graft reconstruction to partially heal acetabular fractures.
Meek and colleaguesfound that female patients are more prone to IAFs after primary total hip arthroplasty, which may be related to osteoporosis. In this study, the proportion of women with acetabular fractures during surgery was 67% which verified to that conclusion.
In this study, 5 patients had developmental dysplasia of the hip, femoral upward movement, acetabular hyperplasia, and a large number of osteophytes around the acetabulum, which caused difficulty in exposing the acetabulum and uneven acetabular grinding. THA in hip dysplasia is associated with increased risks of periprosthetic fractures owing to the disuse osteopenia and poor quality of the bone Therefore, when driving into the acetabular prosthesis, the external force required by the prosthesis holder is greater, and it is more likely to cause fractures. Therefore, it is necessary to fully expose the acetabulum during surgery to avoid blind and violent penetration into the prosthesis.
In this study, 6 patients with ankylosing spondylitis involving hip joints had severe hip flexion deformities. The ipsilateral pelvis tilted forward on the x-ray film, the acetabular contour, and abduction angle changed, and the template measurement could not be accurate. Determine the placement position and angle of the prosthesis, causing the displacement of the prosthesis during the operation. At the same time, the IAFs is closely related to the surgeon's operating skills, especially before the hip dislocation, because the hip joint fusion often requires pre-osteotomy. It is more difficult to handle. The patient 1 in this study had a total fracture of the anterior wall of the acetabulum during the operation, and a full-thread screw was added to the fracture site. Fixation, acetabular stability during intraoperative testing, and good prognosis after follow-up.
Previously, it was thought that when acetabular sclerosis and ivory are susceptible to fractures under violence, osteoporosis is the main risk factor[6, 19, 21, 22]. In this study, patients 7 and 14 had severe bone Looseness, fractures of the posterior wall of the acetabulum during the operation, unstable test during the operation, and internal fixation with plate screws were given. The patient had a good prognosis and no joint dislocation occurred.