Acetabular fracture open reduction and internal fixation in patients under 60: time to total hip arthroplasty and implant survivorship: a systematic review.

Abstract

Acetabular fractures in young patients are usually treated with open reduction and internal fixation (ORIF) to preserve the native joint. Despite this, many develop post-traumatic arthritis, needing conversion to total hip arthroplasty (THA). The timing of THA and the long-term survival of these implants remain uncertain. We systematically reviewed the literature to determine the interval from ORIF to THA and to evaluate implant survivorship. We searched PubMed, Embase, Scopus, and Web of Science for studies reporting outcomes of patients <60 years who underwent ORIF for acetabular fracture and later THA. Data extracted on patient demographics, fracture type, time to THA, survivorship, and complications. Pooled estimates were calculated using random-effects models, and survivorship summarised using Kaplan-Meier methods. 12 studies including, ~450 patients met inclusion criteria. The pooled mean time from ORIF to THA was approximately 5.2 years (95% CI, 3.7-6.6). Between a ¼ and ⅓ of patients required THA at longer follow-up. Implant survivorship was 95% at 5 years and 85-90% at 10 years, declining to 70-80% at 15 years. Outcomes were worse in complex fracture patterns. Cementless fixation and modern porous ingrowth cups achieved survivorship similar to primary THA. Complications were more common than in primary THA, including dislocation (~10%), infection (~7%), and reoperation (~15%). In patients under 60, ORIF usually delays the need for THA by several years, but conversion is required in a substantial population. Conversion THA restores function and achieves acceptable survivorship, although it remains technically demanding, with higher complication rates than primary THA.