gms | German Medical Science

Objectives: The overall goal in surgical treatment of displaced acetabular fractures is to preserve the native hip joint as long as possible. Only few large studies have evaluated the outcome.

We assessed (1) the long-term survivorship of hips after surgical treatment of acetabular fracture, and (2) identified factors predicting the conversion to total hip arthroplasty (THA).

Methods: We performed a retrospective study of 267 consecutive patients treated with open reduction and internal fixation for an acetabular fracture between October 1990 and January 2013 at our institution. We excluded all cases with incomplete radiographic documentation and without a minimum follow-up of 2 years. Cases with conversion to THA were included at any time. This left 211 patients available for analysis with a complete dataset. All patients were then contacted and evaluated if they had been converted to THA. The follow-up ranged from 2 to 20.1 years. We then calculated a Kaplan-Meier-survivorship curve with conversion to THA as the endpoint. A Cox-regression analysis was performed to find demographic, intraoperative, and radiographic factors predicting the need for THA.

Results and Conclusion: (1) The cumulative survivorship of the hip was 87% at 2 years, 85% at 5 years, 79% at 10 and 20 years. 50.0% of the failures occurred in the first year after trauma and 76.5% within two years. (2) The following significant negative predictors were identified: marginal impaction (hazard ratio [HR] 10.1), posterior wall involvement (HR 30), preoperative displacement greater than 20mm (HR 3.6), femoral head cartilage lesion (HR 4.9), non-anatomical reduction (HR 9.1).

The overall survivorship 20 years after an acetabular fracture is 79%, which is comparable to the duration of THA. If hips get arthritic, they typically tend to fail early after trauma.