The Predictive Factors for Post-Traumatic Hip Osteoarthritis After Surgical Treatment of Acetabular Fractures: A Retrospective Cohort of 130 Patients.

Background/

Objectives

Post-traumatic hip osteoarthritis (PTHOA) remains the principal long-term complication after operatively treated acetabular fractures. The relative weight of patient-, injury-, and surgeon-dependent variables that drive its development is still debated. We aimed to identify independent predictors of PTHOA after open reduction and internal fixation (ORIF) of acetabular fractures.

Methods

We retrospectively reviewed 130 consecutive patients who underwent ORIF for an acetabular fracture at a single tertiary trauma centre between November 2012 and January 2023 and had a minimum follow-up of 24 months. Fractures were classified using the Judet-Letournel system; reduction quality was graded according to Matta. PTHOA was assessed at the latest follow-up using both the Tönnis and Kellgren-Lawrence (KL) systems. Patients were stratified into three groups: no OA, mild OA (Tönnis 1/KL 1-2), and advanced OA (Tönnis 2-3/KL 3-4). Univariable and multivariable analyses identified factors independently associated with advanced OA.

Results

The cohort included 106 men (81.5%) and 24 women (18.5%) with a mean age of 40.7 ± 16.3 years and a mean follow-up of 3.4 years. Advanced PTHOA developed in 43 patients (33.1%); 13 (10.0%) underwent THA. On multivariable analysis, prolonged time-to-surgery (>6 days; p = 0.001), associated posterior-wall-transverse fracture (p = 0.038), use of the Kocher-Langenbeck (K-L) approach (p = 0.038), and non-anatomic Matta reduction (p < 0.001) were independently associated with advanced PTHOA. Age ≥ 40 years was significant on univariable analysis (p = 0.002) but not after adjustment.

Conclusions

Reduction quality, associated posterior-wall-transverse fracture morphology, surgical timing, and choice of approach are the principal determinants of PTHOA after acetabular ORIF. Early surgery and meticulous anatomic reduction should remain the cornerstones of management.