Intraoperative acetabular fracture (IAF) is a non-common complication of primary total hip arthroplasty (THA). Despite the prevalence of intraoperative periprosthetic fractures are increasing, little has been written about this type of fracture. The main objective is to analyze possible risk factors, treatment options and functional outcomes associated with IAF.

Between 2006 and 2020, 4 senior arthroplasty surgeons performed 5540 uncemented primary THA. We reviewed our Total Joint Registry and found 18 cases with an IAF. We analyzed demographic factors, medical history, preoperative diagnose, acetabular cups designs, anatomic location of the fracture, treatment, associated complications and functional outcomes. The minimum duration of follow-up was 12 months.

The prevalence of an IAF was 0,3%. All the acetabular cups were hemispherical modular. The most frequent acetabular cup associated with an IAF was the CSF Plus (JRI). In two cases the acetabular components were judged to be stable and no additional treatment was done. In the other sixteen patients, various surgical procedures were carried out. Almost 30% of patients that sustained an IAF had some complication during their follow up. Moreover, poor functionality outcomes were obtained (12.1 ± 4.1). in the final follow up accordance to Postel Merle d’Aubingé score.

Although IAF is a rare complication of THA, maintaining a high index of suspicion is important as they can be difficult to identify. Still with an adequate early treatment they have poor functionality and high risk of associated complications.