Article
20-year survivorship of the hip following operative treatment of 1,208 acetabular fractures
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Authors
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M. Tannast
- Universität Bern, Inselspital, Orthopädie, Bern, Switzerland
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S. Najibi
- The Hip & Pelvis Institute, Santa Monica, USA
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J.M. Matta
- The Hip & Pelvis Institute, Santa Monica, USA
| Published: | October 18, 2011 |
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Outline
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Questionnaire: The aims of the study were (1) to determine the cumulative 20-year survivorship of the hip after open reduction and internal fixation of displaced acetabular fractures; (2) to detect factors predicting the need for total hip arthroplasty (THA) or hip arthrodesis; and (3) to create a predictive model for clinical practice that calculates the probability for the need of early THA or hip arthrodesis.
Methods: 1,208 acetabular fractures operated by a single surgeon over a 26-year period were analyzed. The cumulative 20-year Kaplan-Meier survivorship analysis of the hip including a best- and worst-case scenario were calculated with THA/hip arthrodesis as endpoints. A uni-/multivariate Cox-regression analysis was performed to find negative predictors which were then used to construct a nomogram predicting the individual probability for the need of an early THA.
Results and conclusions: The cumulative 20-years survivorship of the native hip was 79% at 20 years. The best and worst-case scenario revealed a cumulative 20-years survivorship of 86% and 52% respectively. Significant independent negative predictors were non-anatomical reduction, age >40 years, anterior dislocation, postoperative incongruence of the acetabular roof, involvement of the posterior wall, acetabular impaction, femoral head cartilage lesion, initial displacement of the articular surface >20 mm, and the utilization of the extended iliofemoral approach. Based on these factors, a nomogram is presented for prediction of the need for an early THA. Open reduction and internal fixation of acetabular fractures can successfully prevent the need for subsequent THA after 20 years in nearly 80% of all cases. External prospective validation of the nomogram may support the wider use of this prognostic baseline model for patients with open reduction and internal fixation of displaced acetabular fractures. The number of evaluated fractures and the length of follow-up are unique for acetabular fractures in particular and for any type of articular fractures in general. The results represent benchmark comparative data for any future and past studies on the outcome after surgical fixation of acetabular fractures.
