Comparison of outcomes based on treatment type for geriatric acetabular fractures: A systematic review and...

Acetabular fractures in geriatric patients are increasing in frequency and present unique challenges due to poor bone quality and pre-existing osteoarthritis. High rates of secondary conversion to Total Hip Arthroplasty (THA) have led to the increased use of a "Fix and Replace" strategy (Trauma Arthroplasty). This systematic review and meta-analysis compares clinical outcomes and complications of ORIF with primary THA/Combined Hip Procedure (CHP) based on fracture-based treatment strategies in the elderly.

A systematic literature search was conducted (PubMed, Embase, Cochrane, and Web of Science) for studies published between 1997 and 2025 involving patients aged ≥55 years with acetabular fractures. We compared ORIF (n = 2034) versus Arthroplasty (CHP/THA, n = 417) [Synthesized from updated dataset]. Primary outcomes were functional scores (Harris Hip Score and Oxford Hip Score), 90-day and 1-year mortality rates, and reoperation/conversion rates. Absolute numbers and pooled odds ratios (OR) were calculated using a random-effects model RESULTS: Out of 2163 screened articles, 20 (0.9%) were included in this study, encompassing a total cohort of 2703 patients. The mean age of the study population was 74.14 years (SD 6.97), with a mean ASA score of 2.8. The primary THA/CHP group achieved a significantly higher postoperative Harris Hip Score with a mean of 73.6 compared to 66.3 in the ORIF group at three months (p < 0.05). Surgical intensity was higher in the "Fix and Replace" cohort in several series, which demonstrated a significantly longer median operative time (185 vs. 125 min, p < 0.001) and an increased intraoperative blood loss (median 1000 ml vs. 500 ml, p = 0.006) compared to isolated ORIF. The 90-day mortality rate was 11% for ORIF and 15% for THA/CHP, showing no statistically significant difference (OR 1.08; 95% CI 0.58-2.02; p = 0.82). Patients initially treated with ORIF had a significantly higher risk of failure requiring secondary surgery, with a 14-45% conversion rate to THA due to post-traumatic osteoarthritis or hardware failure. The primary THA/CHP group had a significantly lower reoperation rate of 4.4% to 7.7%, yielding a pooled odds ratio of 2.34 (95% CI 1.31-5.67; p < 0.001) in favor of primary arthroplasty CONCLUSION: Primary Trauma Arthroplasty (Fix and Replace) provides superior functional outcomes and lower reoperation rates compared to ORIF alone in geriatric patients with comminuted acetabular fractures or joint impaction. While surgical intensity is higher, the avoidance of "failed" osteosynthesis and subsequent complex revision surgery suggests that primary THA is a viable first-line treatment for selected elderly patients.