Related Experiment Video
Updated: Sep 12, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Outcomes of Total Hip Arthroplasty Versus Open Reduction Internal Fixation for Acetabular Fractures in Older Adults
Priya Singh1, Carolina Stocchi1, Brocha Z Stern1,2
1Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.
Objectives:
To compare outcomes of total hip arthroplasty (THA) versus open reduction internal fixation (ORIF) for acetabular fractures in older adults using a large national database.
Design:
Retrospective cohort study using the Medicare Limited Data Set.
Setting:
Seven hundred ninety-eight acute short-stay hospitals.
Patient Selection Criteria:
Fee-for-service Medicare beneficiaries aged 65+ years who underwent inpatient ORIF or THA for acetabular fractures (OTA/AO 62) (without associated femoral fractures) from January 2013 to December 2020 were included.
Outcome Measures And Comparisons:
To minimize confounding, 1 patient with THA was matched with up to 2 patients with ORIF based on sociodemographic factors, comorbidities, and surgery year using a propensity score approach. Multivariable generalized linear models identified adjusted associations between surgery type and outcomes; adjusted odds ratios (ORs) or mean differences with 95% confidence intervals were reported.
Results:
Among 5656 eligible procedures, the matched cohort included 2879 patients (1027 THA, mean age 78.6 years, 42.3% men; 1852 ORIF, mean age 78.6 years, 42.4% men). Patients with THA (vs. ORIF) had an increased odds of 30-day and 90-day hospital returns (30-day: OR = 1.54, P < 0.001; 90-day: OR = 1.25, P = 0.01) and 90-day and 1-year infection (90-day: OR = 1.92, P < 0.001; 1-year: OR = 1.74, P < 0.001). THA was also associated with higher odds of 90-day reoperation (OR = 2.47, P < 0.001) but not 1-year reoperation (OR = 0.84, P = 0.16). No significant associations were observed for hospital length of stay ( P = 0.42), discharge disposition ( P = 0.93), use of 90-day home health services ( P = 0.13), 90-day venous thromboembolism ( P = 0.75), or 1-year mortality ( P = 0.65).
Conclusions:
Patients who underwent THA for acetabular fractures were more likely to return to the hospital within 30 and 90 days postsurgery, have an infection in the year after surgery, and undergo a reoperation in the 90-day postoperative period than those who underwent ORIF. Further investigation of the mechanisms of the observed associations is necessary to understand which surgical approach provides optimal outcomes.
Level Of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
07:43In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
Published on: July 2, 2021
