Navigated percutaneous column screw fixation combined with total hip arthroplasty for non-reconstructable acetabular fractures in geriatric patients.

Abstract

Periprosthetic acetabular fractures and acetabular fractures are becoming increasingly common in the elderly population. The ultimate treatment goal in these patients should include immediate unrestricted mobilisation. Additionally, the burden of the operative procedure should be minimized. We therefore developed a technique of single stage navigated percutaneous screw fixation of the anterior and posterior columns combined with total hip arthroplasty for the treatment of non-reconstructable acetabular fractures in geriatric patients. The aim of this study is to retrospectively evaluate the clinical and radiological outcomes thereafter. This is a single-centre, prospective cohort study. All patients aged ≥ 60 years treated with the above-mentioned procedure at our institution between January 2020 and June 2025 were eligible for inclusion. Patient and surgery related parameters as well as level of independency of living and walking abilities, EQ-5D-5L and Forgotten Joint Score at latest follow-up were recorded. Fifty-two hips in 51 patients (median age 85 years, range 64-95) with 30 (58%) native and 22 (42%) periprosthetic fractures were included. Median intraoperative blood loss was 600 mL (0-2'700). Median operating time was 255 min (range 169-430). Thirty-day mortality was 10% and revision rate 12%. Thirty-six patients (69%) returned to their previous social environment and thirty-four patients (65%) regained pre-traumatic walking abilities. PROMs were available for 28 patients (54%) with a median follow-up of 12 months (2-60). Radiographic follow-up was available for 39 hips (75%) with a median of 7.3 months (2-60) demonstrating a stable cup in 37 cases (95%) whereas loosening was observed in 2 cases (5%), subsequently leading to revision in 1 patient. Navigated percutaneous screw fixation of the anterior and posterior columns combined with total hip arthroplasty may lower the impact of surgery in a rather frail cohort of geriatric patients. The buttressing effect of the column screws may enhance overall stability of the cup even without fracture reduction, thus providing a stable construct to allow immediate unrestricted weight bearing. Preinjury levels of independency and walking abilities could be fully restored in the majority of our cohort. LEVEL OF EVIDENCE 3: Non-randomized follow-up study.