To Fix or Replace? A Systematic Review and Meta-Analysis on Surgical Management of Acetabular Fractures in the Elderly.

Abstract

Acetabular fractures in the elderly are increasingly common and associated with high morbidity and mortality. While open reduction and internal fixation (ORIF) has been the mainstay of treatment, elderly outcomes have been less consistent. Acute total hip arthroplasty (THA), with or without fixation (combined hip procedure, CHP), is an alternative approach that may facilitate earlier mobilization and reduce early reoperation. This systematic review and meta-analysis compared outcomes of ORIF versus acute THA/CHP for acetabular fractures in patients aged 60 years and older. A systematic review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched from 2000 to the present. Comparative studies reporting outcomes for ORIF and THA/CHP in patients aged ≥ 60 years were included. Reviewers independently screened and extracted data on demographics, interventions, complications, functional outcomes, and patient-reported outcome measures (PROM). Pooled incidence rates, risk ratios (RR), and mean differences (MD) were calculated using random-effects models. There were 13 studies and 949 patients (ORIF: 620; THA/CHP: 329) included. The pooled mean age was 74 years (range, 60 to 93). The ORIF patients were younger (MD: -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02). Reoperation was more common after ORIF (RR: 2.60; 95% confidence interval [CI]: 1.42 to 4.75; P = 0.002), with 84% of conversions due to post-traumatic osteoarthritis (PTOA). The median time to conversion THA was 14.7 months. The PTOA incidence was 34% following ORIF; dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores (HHS) at one to two years postoperatively were higher in the arthroplasty group (MD -6.11; 95% CI: -9.90 to -2.31; P = 0.002). Acute THA/CHP may offer a viable treatment option in the elderly, demonstrating lower reoperation rates and improved function compared to ORIF.