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 |
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| Institution: | 1. Orthopedic Trauma Surgeon, Department of Orthopedic Trauma, Nottingham University Hospitals, Nottingham, UK;2. Chief of Orthopedic Trauma, Detroit Medical Center, Professor of Orthopedics, Wayne State University, 9B University Health Center, Detroit Receiving Hospital, 4201 St. Antoine Boulevard, Detroit, MI, 48201 United States;3. Professor of Orthopedics, 0490 McCaig Tower, Foothills Medical Center 3134 Hospital Dr NW Calgary, Alberta, T2N 5A1 Canada;1. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA USA;2. Department of Orthopaedic Surgery, UTHealth McGovern Medical School, Houston, TX USA;1. Department of Orthopaedic surgery, CHA Bundang medical center, CHA university, Korea;2. Department of Orthopaedic surgery, Gyeongsang national university, college of medicine, Gyeongsang national university Changwon hospital, 1, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea;1. The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia;2. The Australian National University, Canberra, Australian Capital Territory, Australia;3. The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia;1. Department of Orthopedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA;2. R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA;1. Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China |
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| Abstract: | IntroductionThe 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.MethodsInclusion 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.ResultsForty-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.ConclusionsIn 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. |
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