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Combined Hip Procedure Versus Open Reduction and Internal Fixation for Displaced Acetabular Fractures in Patients Older than 75 years: A Matched Cohort Study

par Kahhaleh, Edward ;Belzile, Étienne E.L.;Reed-Métayer, Thomas;Dartus, Julien;Plante, Dominic;Lesieur, Martin;Lamontagne, Jean;Bédard, Luc;Pelet, Stéphane
Référence Journal of orthopaedic trauma, 37, 12, page (601-606)
Publication Publié, 2023-12

Article révisé par les pairs

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Résumé :

Objective:To compare surgical outcomes between combined hip procedure (CHP: open reduction and internal fixation [ORIF] with total hip replacement) and ORIF alone for the treatment of displaced acetabular fractures in a geriatric population.Design:Retrospective case-control study.Setting:Academic Level 1 trauma center.Patients:Consecutive patients from 2012 till 2020 with acetabular fractures fitting inclusion criteria were enrolled.Intervention:Combined hip procedure or ORIF alone for displaced acetabular fractures.Main Outcome Measurement:Revision surgery at the latest follow-up, defined as the need for implant revision in the CHP group and conversion to total hip replacement in the ORIF group.Results:The need for revision surgery was lower in the CHP group (12.5%) compared with the ORIF alone group (25%). The median time for conversion to total hip replacement in the ORIF alone group was 2.6 years. Ten-year survivorship was significantly higher in the CHP group (85.7% vs. 45.8%, P < 0.01). Patients in the CHP group presented with higher American Society of Anesthesiologists and Charlson index scores and had more marginal impaction and concomitant femoral head fractures.Conclusions:In patients older than 75 years presenting with a displaced acetabular fracture with marginal impaction or femoral head fracture, survivorship of CHP is higher than ORIF alone. A combined hip procedure should be considered in such patients.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.