Impact of postoperative complications on patient-reported outcomes following surgical fixation of acetabular fractures.

Abstract

Acetabular fractures frequently require surgical fixation and carry high rates of complications. The impact of these complications on patient-reported recovery remains unclear. This study evaluated whether complications are associated with worse outcomes at 6 months postoperatively. We retrospectively reviewed adults with AO/OTA 62 acetabular fractures treated operatively at a single Level I trauma center from June 2022 to October 2024. Patients who completed 6-month surveys were included. Outcomes were 6-month scores for PROMIS Physical Function (PF), Pain Interference (PI), Global Physical Health (GPH), Global Mental Health (GMH), Anxiety/Depression, Brief Resilience Scale (BRS), and percent of normal function. Patients were grouped by complication status, defined as fracture-related infection, venous thromboembolism, Brooker III-IV heterotopic ossification, or conversion to total hip arthroplasty. Scores were compared using t-tests for continuous variables and chi-square/Fisher exact tests for categorical variables, with significance set at p ≤ 0.05. A total of 109 patients (mean age 50.6 years; 64.2 % male) were included; 22 (20.2 %) experienced at least one postoperative complication, most commonly conversion to total hip arthroplasty (THA) (11.9 %). At six months, patients with complications reported worse PROMIS scores than those without: PF 31.9 vs 40.2 (p = 0.002), PI 65.1 vs 59.2 (p = 0.016), GPH 35.2 vs. 42.8 (p = 0.002), and GMH 39.5 vs 45.8 (p = 0.021). Patients with fracture-related infection exhibited lower PF (28.8 vs 39.3, p = 0.021). Those converted to total hip arthroplasty demonstrated lower PF (31.4 vs 39.5, p = 0.020) and GPH (34.4 vs 42.3, p = 0.007). At one year (n = 81), scores remained lower in the complication cohort, but differences were not statistically significant. Postoperative complications after acetabular fracture fixation are associated with clinically meaningful and statistically significant worse patient-reported physical function and global health, and higher pain interference at six months.