Complications Following Total Hip Arthroplasty in Patients Who Have Acetabular Fracture Versus Primary Osteoarthritis: A Retrospective Cohort Analysis.

Abstract

Total hip arthroplasty (THA) following geriatric acetabular fractures provides benefits including early weight-bearing and accelerated rehabilitation; however, it involves a technically complex procedure with potentially high complication rates. This study aimed to evaluate the frequency of complications in patients undergoing acute THA (aTHA) after an acetabular fracture. A collaborative network database was queried to identify patients aged 65 years and older who underwent THA between 2004 and 2024 following an acetabular fracture. The control cohort consisted of patients who underwent THA for primary osteoarthritis. Cohorts were propensity-matched based on age, sex, and comorbidities. Medical and surgical complications were analyzed during both the early (seven, 14, and 30 days) and delayed (90 days, 180 days, one year, and two years) postoperative periods. After 1:1 propensity score matching, both cohorts included 799 patients. Patients in the aTHA group demonstrated a higher risk of pneumonia, stroke, opioid use, rehospitalization, and urinary tract infections in both the early and delayed postoperative periods (P ≤ 0.05). Additionally, acute kidney injury and blood loss anemia were more common among the aTHA group in the early postoperative period, while deep infection/periprosthetic joint infection, sepsis, deep vein thrombosis, pulmonary embolism, emergency department visits, and death were more common in the delayed period (P ≤ 0.05). At 2-year follow-up, the aTHA group had higher rates of prosthetic hip dislocation (10.4 versus 1.3%; relative risk [RR] 8.30, P < 0.001), periprosthetic fracture (3.1 versus 1.3%; RR 2.50, P = 0.010), and revision THA (6.4 versus 2.5%; RR 2.55, P < 0.001) compared to the control group. Patients undergoing aTHA following an acetabular fracture experience higher rates of complications, including prosthetic hip dislocation, periprosthetic fracture, and revision THA, compared to those undergoing THA for primary osteoarthritis. Prognostic level III.