The fate of acetabular fracture fixation at 10 years: rates of conversion to arthroplasty

Abstract

Background: Post-traumatic arthritis, implant failure, non-union or avascular necrosis may result in a total hip arthroplasty (THA) after acetabular fracture fixation (AFF). The aim of this study was to report the occurrence of THA after AFF and analyse factors that predict its occurrence. Patients and methods: All patients with AFF between 2010 and 2014, in a major trauma centre, were included. Patients treated conservatively or with acute THA were excluded. Data regarding classification of fracture, details of surgery and follow-up using EQ-5D and Oxford Hip Score (OHS) were recorded prospectively. Postoperative radiographs and CT scans were analysed for accuracy of reduction. The number of patients who underwent secondary THA and indications were recorded. Results: 122 patients with a mean age of 42 years were included. At a mean follow-up of 10 years, the mean OHS was 39 (range 22–48) and EQ-5D was 22 (range 10–25). THA was performed in 10 patients (8%), 50% of which were performed between 2–5 years after AFF. Age >40 years, posterior dislocation and presence of posterior wall fracture, were the only factors associated with progression to THA. The survivorship of fixation at 5 years was 95% (95% CI, 91–98%) and at 10 years was 91% (95% CI, 86–96%). Conclusions: Conversion to THA after AFF was 8%, with even anatomically reduced posterior wall fractures having a poor prognosis. A period of follow-up of at least 5 years is suggested in patients with risk factors.