Open reduction and internal fixation alone versus open reduction and internal fixation plus total hip arthroplasty for displaced acetabular fractures in patients older than 60 years: A prospective clinical trial. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Manson, Theodore T.; Slobogean, Gerard P.; Nascone, Jason W.; Sciadini, Marcus F.; LeBrun, Christopher T.; Boulton, Christina L.; O'Hara, Nathan N.; Pollak, Andrew N.; O'Toole, Robert V.
• Is Part Of: Injury. Volume 53:Issue 2(2022)
• Page Start: 523
• Page End: 528
• Publication Date: 2022-02
• Subjects: Elderly acetabular fractures -- Open reduction and internal fixation -- Total hip arthroplasty -- Displaced acetabular fractures -- Reoperation; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.09.048
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The first prospective clinical trial to our knowledge, comparing ORIF versus ORIF + THA for geriatric acetabular fractures. ORIF + THA decreased the absolute risk of reoperation by 28% (95% CI, 13% to 44%, p < 0.01) compared to only ORIF treatment. We did not observe differences in patient satisfaction and other validated outcome measures between the treatment groups. Our results confirm that a combined ORIF + THA strategy can be safely performed in these challenging injuries. Abstract: Introduction: The optimal treatment of elderly patients with an acetabular fracture is unknown. We conducted a prospective clinical trial to compare functional outcomes and reoperation rates in patients older than 60 years with acetabular fracture treated with open reduction and internal fixation (ORIF) alone versus ORIF plus concomitant total hip arthroplasty (ORIF + THA). Our hypothesis was that patients who had ORIF + THA would have better patient reported outcomes and lower reoperation rates postoperatively. Methods: Inclusion criteria were patients older than 60 years with acetabular fracture plus at least one of three fracture characteristics: dome impaction, femoral head fracture, or posterior wall component. Eligible patients were operative candidates based on fracture displacement, ambulatory status, and physiological appropriateness. Patients received either ORIF alone or ORIF + THA (accomplished at same surgery through same incision). Outcome measurements included Western Ontario and McMaster Universities Osteoarthritis Index hip score, Short Form 36, Harris Hip Score, and Patient Satisfaction Questionnaire Short Form scores. Additionally, patients were monitored for any unplanned reoperation within 2 years. Results: Forty-seven of 165 eligible patients with an average age of 70.7 years were included. The mean Harris Hip Score difference favored ORIF + THA (mean difference, 12.3, [95% confidence interval (CI), -0.3 to 24.9, p = 0.07]). No clinically important differences were detected in any other validated outcome score or patient satisfaction score 1 year after surgery. ORIF + THA decreased the absolute risk of reoperation by 28% (95% CI, 13% to 44%, p < 0.01). No postoperative hip dislocation occurred in either group. Conclusions: In patients older than 60 years with an operative displaced acetabular fracture with specific fracture features (dome impaction, femoral head fracture, or posterior wall component), treatment with ORIF + THA resulted in fewer reoperations than treatment with ORIF alone. No differences in patient satisfaction and other validated outcome measures were detected.