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Abstract
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Introduction: There is a significant increase of acetabular fractures in the elderly in recent years. If surgery is chosen the standard treatment for displaced acetabular fractures is open reduction and internal fixation (ORIF). The place of total hip arthroplasty (THA) as an acute treatment for acetabular fracture in the elderly is not well defined. The aim of this study is to compare outcomes between ORIF and ORIF combined with acute THA for acetabular fracture in the elderly. Methods: From 2007 to 2018, 189 patients were treated surgically for an acetabular fracture in our institution. Fifty-one patients were older than 65 years and were retrospectively reviewed. Twenty-five were treated with ORIF, and 26 with ORIF and acute THA. We analysed the outcome focusing on intraoperative as well as early/late complications, operating time, blood loss, functional outcome with the Harris Hip Score (HHS), revision rate and length of hospital stay. Results: The mean age for the ORIF group was 75.4 years (66-92); the mean age for the THA group was 78.2 years (66-88). Charlson comorbidity index were similar (1.7 vs 1.8). Mean blood loss for ORIF was 690 mL (250-1800) versus 962 mL (400-1700) for THA group. Mean surgery time was 135 minutes (54-305) for ORIF group versus 186 minutes (106-250) for the THA group. Mean Harris Hip score (HHS) for ORIF was 68.25 (24-92) versus 74.5 (51-89) in THA group with a mean follow up time of respectively 12.9 and 14.4 months. Twenty-four percent of ORIF group had an early complication versus 23 % for THA. Three patients (12 %) of the ORIF group were converted to THA (1 arthrosis, 1 necrosis, 1 intra-articular screw) with mean HHS of 88.5 after conversion (HHS before of 53.5). The other revision in the ORIF group concerns an infection. Revision rate for THA was 11.5 % (2 infections and 1 instability). Mean length of post-operative hospital stay was 15 days for the ORIF group versus 13 days for THA group. Conclusion: Although surgical time and perioperative bleeding are more elevated in THA group, it seems to be an efficient procedure with equivalent complications and revision rate, and better outcome. Acute THA combined with ORIF for acetabular fractures in the elderly seems to be a safe procedure in selected patients, based on surgeon experience, articular destruction, pre-existent arthrosis and patient comorbidities. After THA combined with ORIF, full weight bearing is possible, which is an important factor for this old population.
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