Patients with an acetabular fracture treated with acute total hip arthroplasty and additional fixation: a cohort study with functional and radiological follow-ups.

BACKGROUND AND PURPOSE: Elderly patients with acetabular fractures are associated with complex fracture patterns and poor bone quality. Internal fixation alone in these patients has been associated with poor outcome. Internal fixation combined with acute total hip arthroplasty (THA) has been introduced as a surgical option aimed to allow early recovery of hip function and mobility. However, functional and radiological data are still limited. The aim of our study was to elucidate radiographic and functional outcomes, and complications in elderly patients with an acetabular fracture treated with acute THA and additional fixation (reinforcement ring and/or plate fixation).

METHODS

Patients ≥ 60 years with an acetabular fracture treated with acute THA and additional acetabular fixation were followed up at least 1 year postoperatively. Medical records were reviewed, and functional examinations and radiographic assessments were performed.

RESULTS

84 patients were identified, of whom 32 completed all follow-ups. The median (IQR, range) age was 77 (35, 60-95) years and 7 of 32 were females. Dome impaction was the main indication for THA in 30 and the median follow-up time was 3.1 years. 2 patients had a postoperative hip dislocation. 3 patients had a deep infection and 7 sustained at least 1 non-surgical complication. The median Harris Hip Score was 87 (33, 33-100) and the median EQ-5D-3L index score was 0.7 (0.5, 0.0-1.0). No radiological signs of loosening of the acetabular reinforcement ring or the cup were observed. The 1-year mortality for the whole eligible cohort was 13% (n = 9/72).

CONCLUSION

Internal fixation with acute THA in elderly acetabular-fracture patients resulted in good functional outcomes with no signs of acetabular implant loosening, but a high complication rate.