Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

Abstract

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student's t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis

“…Two hundred and fifteen studies underwent full-text review and 205 were excluded for reviews or case series or one arm study or different inclusion criteria or without full text abstracts. Finally, ten studies ( 16 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ) were included in the systematic review.

Figure 1 PRISMA flow diagram of study selection.

…”

“…( 23 ) 67 ± 8.3 (56–89) 63.7 ± 39.5 (24–188) NA NA NA 47 44 2 NA ORIF 58 aTHA + ORIF 9 Carta et al . ( 24 ) 39.6 (3–96) NA NA ORIF 31 20 11 73.2 (65–93) …”

“…( 23 ) ORIF Acceptable reduction 58 58 Acceptable reduction, <4 hours OP time AA / PA Plates/screws aTHA + ORIF AA / PA Irreducible 9 9 Irreducible, OP >4 hours, severe acetabular or femur head impaction, displaced femur neck fracture, OA, osteoporosis Plates/screws Carta et al . ( 24 ) Based on patients' decision ORIF 31 Others 19 AA / PA / ; PA+AA NA QPD 9 Wiper plates …”

“…Other than ORIF, alternatives are percutaneous or minimally invasive reduction and acute or delayed THA ( 22 ). Despite the disputable treatment options, general consensus are the necessities for verticalization and early mobilization of the patient, in order to restore the pre-traumatic function and reduce complications ( 24 ).…”

Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating

“…The option of THA is mostly considered in patients with additional fractures of the femoral neck, pathologic fractures or an advanced osteoarthritis of the hip [ 5 ]. A clinical study by Carta et al investigated THA compared to open reduction and internal fixation in acetabular fractures in elderly patients and found advantages for THA regarding surgical time, length of stay, and quality of life and hip function [ 6 ]. In case of fracture stabilization by means of arthroplasty, two different therapy regimens exist.…”