The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hip

Post-Traumatic Hip Arthritis

Post-traumatic hip arthritis develops after a fracture of the acetabulum (hip socket) or a hip dislocation — injuries that disrupt the smooth articular surfaces required for pain-free hip function. Like post-traumatic knee arthritis, this condition often affects relatively younger patients and can present decades after the original injury. Managing it successfully requires expertise in total hip arthroplasty under technically demanding conditions — distorted anatomy, prior hardware, and acetabular bone defects. At Maryland Orthopedic Specialists, our Adult Reconstruction team is experienced in complex primary THA for post-traumatic hip disease.

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What is post-traumatic hip arthritis?

Acetabular fractures occur from high-energy trauma — motor vehicle accidents, falls from height — or, increasingly, low-energy mechanisms in osteoporotic elderly patients. Even with excellent open reduction and internal fixation (ORIF), the articular cartilage damage sustained at the time of injury initiates chondral breakdown.

Acetabular fractures occur from high-energy trauma — motor vehicle accidents, falls from height — or, increasingly, low-energy mechanisms in osteoporotic elderly patients. Even with excellent open reduction and internal fixation (ORIF), the articular cartilage damage sustained at the time of injury initiates chondral breakdown. Post-traumatic arthritis develops in 20–50% of acetabular fracture patients within 5–10 years.

Hip dislocation — posterior dislocation being most common — causes direct cartilage injury at dislocation and may compromise blood supply to the femoral head, leading to avascular necrosis (AVN) in 2–15% of cases depending on time to reduction. AVN of the femoral head can cause further collapse and secondary arthritis.

Both mechanisms ultimately destroy the joint surface, leading to painful, end-stage arthritis.

Treatment options

Non-Surgical

Weight reduction, anti-inflammatory medications, activity modification, assistive devices (cane), and intra-articular corticosteroid injections manage symptoms in early to moderate disease. Non-operative management is appropriate when the patient tolerates function adequately.

Surgical Procedure

Total Hip Arthroplasty (Hip Replacement)

Complete hip joint replacement removing the arthritic femoral head and acetabulum and replacing them with metal, ceramic, and polyethylene components. Anterior approach technique is available for eligible patients, preserving more muscle tissue.

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Frequently Asked Questions

I had my hip fixed years ago and it was doing well. Why is it painful now?
Cartilage damage at the time of the original injury can be silent for years before arthritis becomes symptomatic. This delayed presentation is characteristic of post-traumatic arthritis.
Does my prior hardware need to be removed before hip replacement?
Possibly, depending on its location and interference with cup placement. This is evaluated on CT scan. In some cases, hardware can be left in place; in others, removal is necessary.
Will I need a hip replacement, and how will I know when it's time?
Hip replacement becomes appropriate when pain from post-traumatic arthritis significantly limits your daily activities and quality of life, and when non-surgical measures — such as activity modification, anti-inflammatory medications, assistive devices, and injections — are no longer providing adequate relief. There is no single X-ray finding that makes replacement mandatory; the decision is primarily guided by your symptoms and functional limitations. At MOS we work with you to time surgery based on your goals and overall health, ensuring you get the most out of your new hip.
Is hip replacement after a prior fracture more complicated than a standard hip replacement?
Yes, post-traumatic hip replacement is generally more complex than primary arthritis surgery. Scar tissue from the original injury or prior surgery can distort normal anatomy and increase bleeding risk. Deformity of the femur or acetabulum from the fracture may require specialized implants, bone grafting, or corrective osteotomy. At MOS, pre-operative planning using advanced imaging and custom implant templates is used routinely for these cases to maximize the safety and durability of the reconstruction.
What is the long-term outlook after hip replacement for post-traumatic arthritis?
Modern hip replacements in post-traumatic arthritis patients have good long-term outcomes, with most implants lasting 15 to 20 years or more. However, post-traumatic cases may have slightly higher rates of complications such as infection (due to prior surgery) and loosening (due to altered bone stock) compared to replacement for primary osteoarthritis. Adhering to your rehabilitation program, maintaining a healthy weight, and attending follow-up appointments with your MOS surgeon are the most important steps to protecting the longevity of your implant.

Meet the specialists

Christopher S. Raffo, MD

Christopher S. Raffo, MD

Orthopedic Surgery · Sports Medicine

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James S. Gardiner, MD

James S. Gardiner, MD

Orthopedic Surgery · Sports Medicine

Meet Dr. Gardiner →

Brian McCormick, MD

Meet Dr. McCormick →
Medically reviewed by Christopher S. Raffo, MD
Last reviewed May 1, 2026

References

  1. Matta JM, Siebenrock KA. Does indomethacin reduce heterotopic bone formation after operations for acetabular fractures? A prospective randomised study. J Bone Joint Surg Br. 1997;79(6):959–963. https://doi.org/10.1302/0301-620X.79B6.7466
  2. Ranawat A, Zelken J, Helfet D, Buly R. Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplasty. 2009;24(5):759–767. https://doi.org/10.1016/j.arth.2008.02.018
  3. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg Br. 2005;87(1):2–9. https://doi.org/10.1302/0301-620X.87B1.14872
  4. Herscovici D Jr, Lindvall E, Bolhofner B, Scaduto JM. The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly. J Orthop Trauma. 2010;24(5):291–296. https://doi.org/10.1097/BOT.0b013e3181c04erd
  5. American Academy of Orthopaedic Surgeons. Hip Fracture Treatment. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/hip-fracture-treatment/