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Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly: A short-term comparison with internal fixation alone after a minimum of two years
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.ORCID iD: 0000-0002-3233-2638
2019 (English)In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 101B, no 4, p. 478-483Article in journal (Refereed) Published
Abstract [en]

Aims

Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called 'combined hip procedure' (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

Patients and Methods

A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.

Results

No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes.

Conclusion

The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP.

Place, publisher, year, edition, pages
2019. Vol. 101B, no 4, p. 478-483
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-382251DOI: 10.1302/0301-620X.101B4.BJJ-2018-1027.R2ISI: 000462754300019PubMedID: 30929478OAI: oai:DiVA.org:uu-382251DiVA, id: diva2:1313556
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved

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Borg, TomasHernefalk, BjörnHailer, Nils P.

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