Fix and replace for acetabular fractures: a decade of outcomes

Fix and replace is the combination of fixation and hip arthroplasty for the treatment of acetabular fractures. This technique is typically performed for elderly patients with complex fracture patterns, whereby fixation alone may not achieve a satisfactory result or allow early unrestricted weightbearing.

This was a retrospective observational study of patients with acetabular fractures treated with fix and replace, identified from a locally maintained, prospectively collected database. Imaging and case notes were reviewed for patient and injury characteristics and outcomes.

Between 2014 and 2024, 92 consecutive cases (91 patients) were identified with a median age of 78 years. Operations performed with a single approach had a significantly lower mean anaesthetic time and intra-operative blood loss than dual approach (4.4 h vs 5.0 h, p = 0.043; 500 ml vs 800 ml, p = 0.036). There were 3 revisions for infection (3.3%) and 5 dislocations (5.4%), one of which was revised, with the other four treated successfully with manipulation only. Mortality rates were 12.5%, 30.9%, and 50% at 1, 3, and 5 years, respectively. Increasing age, dependent pre-operative mobility status, and increasing Charlson Comorbidity Index were all associated with all-time mortality risk (p < 0.001, p < 0.001, and p = 0.002, respectively).

This is the largest series of its kind to date, providing additional information about typical patient and injury characteristics and expected outcomes. Due to the benefits of single rather than dual approach, this should be considered where possible using percutaneous techniques and acetabular component augmentation where required, to minimise operative time and blood loss.