Michael J Weaver1,2, Raymond Malcolm Smith2,3, David W Lhowe2,3, Mark S Vrahas4. 1. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA. 2. Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Boston, MA. 3. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA. 4. Department of Orthopaedic Surgery, Cedars Sinai Hospital, Los Angeles, CA.
Abstract
OBJECTIVES: The goal of open reduction and internal fixation (ORIF) is to anatomically reduce the facture and maintain a congruent hip joint. However, ORIF in the elderly is technically challenging. Therefore, there are advocates for acute total hip arthroplasty (THA) in this patient population. The primary purpose of this study was to evaluate the rate of revision surgery in elderly patients with acetabular fractures treated with ORIF or THA. The secondary purpose was to compare patient's self-reported functional outcomes. DESIGN: Retrospective review. SETTING: Two American College of Surgeons Level 1 trauma centers. PATIENTS/PARTICIPANTS: Thirty-three patients were treated with ORIF and 37 were treated with THA. The mean follow-up was 22 months (range 6-89 months). Patients were interviewed, and radiographs were examined. INTERVENTION: Treatment of displaced acetabular fractures with either ORIF or THA. MAIN OUTCOME MEASUREMENTS: Need for reoperation. Harris Hip Score and SF-36 questionnaire. RESULTS: Those treated with ORIF had a higher rate of reoperation (10/33, 30%) compared with those treated with THA (5/37, 14%); however, this was not statistically significant (P = 0.12). Patients reported better bodily pain scores as measured by SF-36 (48 vs. 39, P = 0.04), and a trend toward improved function as measured by patient reported Harris Hip Scores (82 vs. 63, P = 0.06) in those treated with THA compared with ORIF. CONCLUSIONS: Acute reconstruction of acetabular fractures with THA in the geriatric population seems to compare favorably with ORIF, with a similar rate of complications, but with improved pain scores. In addition, there was a high rate of conversion to THA within 2 years of injury when patients were treated with ORIF. Acute THA as primary treatment in this patient population merits further, more controlled, comparative study. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: The goal of open reduction and internal fixation (ORIF) is to anatomically reduce the facture and maintain a congruent hip joint. However, ORIF in the elderly is technically challenging. Therefore, there are advocates for acute total hip arthroplasty (THA) in this patient population. The primary purpose of this study was to evaluate the rate of revision surgery in elderly patients with acetabular fractures treated with ORIF or THA. The secondary purpose was to compare patient's self-reported functional outcomes. DESIGN: Retrospective review. SETTING: Two American College of Surgeons Level 1 trauma centers. PATIENTS/PARTICIPANTS: Thirty-three patients were treated with ORIF and 37 were treated with THA. The mean follow-up was 22 months (range 6-89 months). Patients were interviewed, and radiographs were examined. INTERVENTION: Treatment of displaced acetabular fractures with either ORIF or THA. MAIN OUTCOME MEASUREMENTS: Need for reoperation. Harris Hip Score and SF-36 questionnaire. RESULTS: Those treated with ORIF had a higher rate of reoperation (10/33, 30%) compared with those treated with THA (5/37, 14%); however, this was not statistically significant (P = 0.12). Patients reported better bodily pain scores as measured by SF-36 (48 vs. 39, P = 0.04), and a trend toward improved function as measured by patient reported Harris Hip Scores (82 vs. 63, P = 0.06) in those treated with THA compared with ORIF. CONCLUSIONS: Acute reconstruction of acetabular fractures with THA in the geriatric population seems to compare favorably with ORIF, with a similar rate of complications, but with improved pain scores. In addition, there was a high rate of conversion to THA within 2 years of injury when patients were treated with ORIF. Acute THA as primary treatment in this patient population merits further, more controlled, comparative study. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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