Combined Hip Procedure Versus Open Reduction and Internal Fixation for Displaced Acetabular Fractures in Patients Older than 75 years: A Matched Cohort Study

Abstract

Objective: To compare surgical outcomes between combined hip procedure (CHP: open reduction and internal fixation [ORIF] with total hip replacement) and ORIF alone for the treatment of displaced acetabular fractures in a geriatric population. Design: Retrospective case–control study. Setting: Academic Level 1 trauma center. Patients: Consecutive patients from 2012 till 2020 with acetabular fractures fitting inclusion criteria were enrolled. Intervention: Combined hip procedure or ORIF alone for displaced acetabular fractures. Main Outcome Measurement: Revision surgery at the latest follow-up, defined as the need for implant revision in the CHP group and conversion to total hip replacement in the ORIF group. Results: The need for revision surgery was lower in the CHP group (12.5%) compared with the ORIF alone group (25%). The median time for conversion to total hip replacement in the ORIF alone group was 2.6 years. Ten-year survivorship was significantly higher in the CHP group (85.7% vs. 45.8%, P < 0.01). Patients in the CHP group presented with higher American Society of Anesthesiologists and Charlson index scores and had more marginal impaction and concomitant femoral head fractures. Conclusions: In patients older than 75 years presenting with a displaced acetabular fracture with marginal impaction or femoral head fracture, survivorship of CHP is higher than ORIF alone. A combined hip procedure should be considered in such patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.