Comparison of outcomes based on treatment type for geriatric acetabular fractures: A systematic review and meta-analysis.
Sascha Halvachizadeh, Adam J Starr, Louisa Bell et al.
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In 30 seconds
This systematic review and meta-analysis compared open reduction and internal fixation (ORIF) with primary total hip arthroplasty or combined hip procedures in adults aged 55 years or older with acetabular fractures. Across 20 studies and 2703 patients, primary arthroplasty was associated with higher three-month Harris Hip Scores (73.6 vs 66.3) and fewer reoperations. ORIF was followed by conversion to THA in 14–45% of patients. Ninety-day mortality did not differ significantly between groups. Arthroplasty involved greater operative time and blood loss in several series, supporting its consideration for selected patients while underscoring the greater surgical burden.
Key findings
- At three months, mean Harris Hip Score was 73.6 after primary THA/CHP versus 66.3 after ORIF (p < 0.05).
- Reoperation rates were 4.4% to 7.7% after primary THA/CHP; the pooled odds ratio was 2.34 (95% CI 1.31-5.67; p < 0.001) in favor of primary arthroplasty.
- After ORIF, 14-45% of patients underwent conversion to THA for post-traumatic osteoarthritis or hardware failure.
- Ninety-day mortality was 11% with ORIF and 15% with THA/CHP, with no statistically significant difference (OR 1.08; 95% CI 0.58-2.02; p = 0.82).
Why it matters
Geriatric acetabular fractures can be difficult to manage because of poor bone quality and pre-existing joint disease. These pooled findings highlight a trade-off: primary arthroplasty was associated with better early function and fewer subsequent operations, while requiring more intensive surgery in several series. The results help frame treatment selection for patients with complex fractures, but do not establish that one approach is preferable for every patient.
What to keep in mind
The review synthesizes studies with differing treatment strategies and reports; the abstract does not specify how many were randomised. Operative-time and blood-loss comparisons came from several series, and the findings may not apply equally across fracture patterns.