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Clinical Trial
. 2022 Feb;53(2):523-528.
doi: 10.1016/j.injury.2021.09.048. Epub 2021 Oct 2.

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

Theodore T Manson  1 , Gerard P Slobogean  2 , Jason W Nascone  2 , Marcus F Sciadini  2 , Christopher T LeBrun  2 , Christina L Boulton  2 , Nathan N O'Hara  2 , Andrew N Pollak  2 , Robert V O'Toole  2
Affiliations
Clinical Trial

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

Theodore T Manson et al. Injury. 2022 Feb.

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.

Keywords: Displaced acetabular fractures; Elderly acetabular fractures; Open reduction and internal fixation; Reoperation; Total hip arthroplasty.

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Conflict of interest statement

Declaration of Competing Interest T. T. Manson is a paid consultant for DePuy and Stryker; receives royalties from Globus Medical; receives research support from DePuy Synthes; serves as a board or committee member for the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons; serves on the editorial or governing board of Clinical Orthopaedics and Related Research, Journal of Arthroplasty, and Journal of Orthopaedics and Traumatology; all unrelated to this study. G. P. Slobogean reported receiving research funding from the Patient-Centered Outcomes Research Institute, the US Department of Defense, and the National Institutes of Health unrelated to this research; serving as a paid consultant with Smith & Nephew and Zimmer Biomet unrelated to this research; and receiving personal fees from Nuvasive Orthopaedics unrelated to this research. J. W. Nascone is a paid consultant for DePuy Synthes, Smith & Nephew, and Zimmer; receives stock or stock options from Imagen; receives royalties from CoorsTek and DePuy Synthes; all unrelated to this study. M. F. Sciadini is a paid consultant for Globus Medical and Stryker, receives stock or stock options from Stryker, and receives royalties from Globus Medical, all unrelated to this study. C. T. LeBrun serves on the editorial or governing board of the Journal of Bone and Joint Surgery and Journal of Orthopaedic Trauma, and serves as a board or committee member for the Orthopaedic Trauma Association and Society of Military Orthopaedic Surgeons. C. L. Boulton reports no declarations. N. N. O'Hara receives stock or stock options from Arbutus Medical, Inc., unrelated to this study. A. N. Pollak receives royalties from Globus Medical, Smith & Nephew, and Zimmer; receives publishing royalties from AAOS-JBL; serves on the editorial or governing board of NAEMT/JB Learning; and serves as a board or committee member of the Orthopaedic Research and Education Foundation; all unrelated to this study. R. V. O'Toole is a paid consultant for Lincotek and Smith & Nephew, receives stock options from Imagen, and receives royalties from Lincotek, all unrelated to this study. This study was supported by a grant from the Orthopaedic Research and Education Foundation.

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