Acute total hip arthroplasty versus open reduction internal fixation for posterior wall acetabular fractures in middle-aged patients

Abstract

Introduction: Open reduction internal fixation (ORIF) is the standard of care for displaced acetabular fractures, but the inability to achieve anatomic reduction, involvement of the posterior wall, articular impaction, and femoral head cartilaginous injury are known to lead to poorer outcomes. Acute total hip arthroplasty (THA) is a reasonable treatment option for older patients with an acetabular fracture and risk factors for a poor outcome, but it is only described in case series. The purpose of this study is to compare outcomes of ORIF and acute THA in middle-aged patients with an acetabular fracture from a single center. Methods: Retrospective case-controlled study of patients aged 45 to 65 years old with acetabular fractures involving the posterior wall treated with acute THA or ORIF at a level 1 trauma center between 1996 and 2011. Patients were matched by fracture pattern and age at a 2 (ORIF):1 (acute THA) ratio. Functional outcome, complications, and reoperation rates of acute THA and ORIF were compared. Results: Sixteen acute THA patients (average age 56.4 years) and 32 ORIF patients (average age 54.3 years) were evaluated at an average follow-up of 6.2 years (range 1–15.2). The average Oxford Hip Score in the acute THA group was 44 compared to 40 in the ORIF group (P = .075). Complication rates were similar between both the groups. Twelve hips (37%) in the ORIF group had undergone THA or been referred for THA, and 2 revisions (13%) had occurred in the acute THA group. A Kaplan–Meier survival analysis showed that those undergoing acute THA had significantly better survival of their index procedure ( P = .031). Conclusions: Both ORIF and acute THA for high-energy acetabular fractures involving the posterior wall in middle-aged patients can provide excellent results, with acute THA patients achieving improved survival of the index procedure and improved functional scores.

Early Total Hip Replacement for Acetabular Fractures: Does Age Affect the Outcome?

“…Early THR in geriatric acetabular fractures has been studied by many authors [6][7][8]10] while few authors studied early THR for acetabular fractures in younger patients [16,19,20]. We could not find comparative studies in literature comparing the results of early THR for fractures of the acetabulum in the elderly versus the young populations.…”

“…Thirty seven percent of patients in the ORIF group had undergone or been referred for THR by the end of follow up, while 13% of patients in the acute THR group had undergone revision. They concluded that acute THR achieved higher functional scores and significantly better survival of the index procedure [16].…”

“…Poor outcome is expected with non-anatomic reduction, late presentation, posterior wall fracture, impaction of the articular cartilage of the acetabulum, full thickness damage or impaction of the cartilage of the head of femur, associated fractures of the head or displaced fractures of the neck of femur and extensive acetabular fracture comminution [12][13][14][15]. All of these factors, except for quality of reduction, are injury-related factors that are uncontrollable by the surgeon and will only predict poor outcome [16].…”

“…Therefore, in limited indications, acetabular fractures in young patients can be treated by acute THR [16,19,20]. Reviewing the literature, the number of young patients who underwent acute THR for acetabular fractures is relatively low and a few authors studied acute THR in the young patient population [16,19,20].…”

“…MacCormick et al [16] compared acute THR versus ORIF for posterior wall fractures in middle aged patients. After a mean follow up period of 6.2 years, the mean Oxford Hip Score in the ORIF group was 40 compared to 44 in the acute THR group.…”