Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty

Abstract

Introduction: Acetabular fractures (AFxs) are rare injuries considering their incidence. The gold standard of treatment is open reduction and internal fixation (ORIF). Surgical treatment represents a challenge for orthopedic surgeons. Our purpose is to assess the short- to medium-term functional outcomes and complications of surgically treated AFx. We analysed the factors influencing clinical outcomes, the incidence of complications and the predictors of conversion in total hip arthroplasty (THA).Materials and Methods: We retrospectively analysed 102 patients with AFx treated between December 2017 and September 2020. The inclusion criteria were AFx treated with ORIF and more than 12 months of follow-up (FU). We evaluated the quality of reduction with X-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). Postoperative superficial and deep infections, neurological sequelae and deep vein thrombosis were documented. X-rays were performed to confirm the adequacy of fixation and complications. At the final FU, the radiographs were graded according to Matta’s Radiological Outcome Grading, and the clinical outcomes were graded using the Oxford Hip Score (OHS).Results: Of 102 patients, 62 patients were enrolled. The statistical analysis revealed that OHS was influenced by quality of reduction (P=0.033), injury severity score (ISS) (P=0.005) and age (> 75 years) (P=0.029). A significant correlation between the patient’s BMI and the OHS was recorded. The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by the posterior approach (P=0.031) and by an ISS > 15 (P= 0.0003). The analysis showed a correlation between AVN and posterior hip dislocation (P=0.004). OA had a correlation with postoperative quality of reduction (P=0.014). Eight patients required THA. Comparing patients with and without THA, a significant correlation between THA and posterior dislocation (P=0.022), isolated posterior wall fracture (P=0.039) and ISS > 15 (P=0.029) was recorded.Conclusion: Despite the improvement of surgical techniques and perioperative care, a high rate of patients with AFx still develop complications and require THA. Identifying negative predictors to help the management of fractures in elderly individuals is needed. Furthermore, the presence of negative predictors could represent an indication for primary THA.