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Combined Hip Procedure Versus Open Reduction and Internal Fixation for Displaced Acetabular Fractures in Patients
Edward Kahhaleh1,2, Etienne L Belzile1, Thomas Reed-Métayer1
1Division of Orthopedic Surgery, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada.
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.
