Acute Total Hip Arthroplasty Versus Open Reduction Internal Fixation for Posterior Wall Acetabular Fractures in Middle-aged Patients

Overview

Journal OTA Int

Date 2021 May 3

PMID 33937650

Citations 5

Authors

Lauren M MacCormick

Carol A Lin

Jerald R Westberg

Andrew H Schmidt

David C Templeman

Affiliations

Soon will be listed here.

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 (.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.

Citing Articles

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Acute total hip arthroplasty with a highly-porous multi-holes cup in elderly patients after traumatic acetabular fracture: A case series and literature review.

Chiapale D, Vitali F, Rubino F, Colombo M, Formica M Trauma Case Rep. 2024; 52:101070.

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Comparison of patient demographics and patient-specific risk factors for readmissions following open reduction and internal fixation for acetabular fractures.

Ganesan V, Pandya R, Rodriguez A, Horn A, Abdelgawad A, Razi A Eur J Orthop Surg Traumatol. 2024; 34(4):1911-1915.

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Rising incidence of acute total hip arthroplasty for primary and adjunctive treatment of acetabular fracture in older and middle-aged adults.

Patterson J, Wier J, Kumaran P, Adamczyk A Eur J Orthop Surg Traumatol. 2023; 34(7):3509-3521.

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Outcomes of acetabular fractures treated with acute fix and replace versus open reduction and internal fixation in elderly population: a multicentric retrospective study.

Smakaj A, Rovere G, Scoscina D, De Mauro D, Erasmo R, Battiato C Int Orthop. 2022; 46(11):2659-2666.

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References

Matta J . Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996; 78(11):1632-45. View

von Roth P, Abdel M, Harmsen W, Berry D . Total hip arthroplasty after operatively treated acetabular fracture: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2015; 97(4):288-91. DOI: 10.2106/JBJS.N.00871. View

Wylde V, Learmonth I, Cavendish V . The Oxford hip score: the patient's perspective. Health Qual Life Outcomes. 2005; 3:66. PMC: 1283979. DOI: 10.1186/1477-7525-3-66. View

Saterbak A, Marsh J, Nepola J, Brandser E, Turbett T . Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma. 2000; 14(4):230-7. DOI: 10.1097/00005131-200005000-00002. View

Tannast M, Najibi S, Matta J . Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012; 94(17):1559-67. DOI: 10.2106/JBJS.K.00444. View

Romness D, Lewallen D . Total hip arthroplasty after fracture of the acetabulum. Long-term results. J Bone Joint Surg Br. 1990; 72(5):761-4. DOI: 10.1302/0301-620X.72B5.2211750. View

Pennal G, Davidson J, Garside H, Plewes J . Results of treatment of acetabular fractures. Clin Orthop Relat Res. 1980; (151):115-23. View

Kim Y, Park J, Kim J, Kim I . Twenty-Five- to Twenty-Seven-Year Results of a Cemented vs a Cementless Stem in the Same Patients Younger Than 50 Years of Age. J Arthroplasty. 2015; 31(3):662-7. DOI: 10.1016/j.arth.2015.09.045. View

Boraiah S, Ragsdale M, Achor T, Zelicof S, Asprinio D . Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma. 2009; 23(4):243-8. DOI: 10.1097/BOT.0b013e3181923fb8. View

10.

Lin C, Caron J, Schmidt A, Torchia M, Templeman D . Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma. 2014; 29(3):151-9. DOI: 10.1097/BOT.0000000000000164. View

11.

Mears D, Velyvis J . Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002; 84(1):1-9. DOI: 10.2106/00004623-200201000-00001. View

12.

Sermon A, Broos P, Vanderschot P . Total hip replacement for acetabular fractures. Results in 121 patients operated between 1983 and 2003. Injury. 2008; 39(8):914-21. DOI: 10.1016/j.injury.2007.12.004. View

13.

Murray D, Fitzpatrick R, Rogers K, Pandit H, Beard D, Carr A . The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007; 89(8):1010-4. DOI: 10.1302/0301-620X.89B8.19424. View

14.

Boardman K, CHARNLEY J . Low-friction arthroplasty after fracture-dislocations of the hip. J Bone Joint Surg Br. 1978; 60-B(4):495-7. DOI: 10.1302/0301-620X.60B4.711795. View

15.

Moed B, WillsonCarr S, Watson J . Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am. 2002; 84(5):752-8. DOI: 10.2106/00004623-200205000-00008. View

16.

Dawson J, Fitzpatrick R, Carr A, Murray D . Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996; 78(2):185-90. View

17.

Huo M, Solberg B, Zatorski L, Keggi K . Total hip replacements done without cement after acetabular fractures: a 4- to 8-year follow-up study. J Arthroplasty. 1999; 14(7):827-31. DOI: 10.1016/s0883-5403(99)90033-5. View

18.

Haidukewych G . Acetabular fractures: the role of arthroplasty. Orthopedics. 2010; 33(9):645. DOI: 10.3928/01477447-20100722-33. View

19.

Malhotra R, Singh D, Jain V, Kumar V, Singh R . Acute total hip arthroplasty in acetabular fractures in the elderly using the Octopus System: mid term to long term follow-up. J Arthroplasty. 2013; 28(6):1005-9. DOI: 10.1016/j.arth.2012.12.003. View

20.

Field R, Cronin M, Singh P . The Oxford hip scores for primary and revision hip replacement. J Bone Joint Surg Br. 2005; 87(5):618-22. DOI: 10.1302/0301-620X.87B5.15390. View