Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review

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Abstract

Purpose

Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP.

Methods

PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO.

Results

Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2–78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered “good.”

Conclusions

CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes.

Level of evidence

Level of evidence IV.

Related collections

Most cited references 42

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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2025)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Methodological index for non-randomized studies (minors): development and validation of a new instrument.

Karem Slim, Emile Nini, Damien Forestier … (2003)

Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialties for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the kappa-coefficient and good internal consistency by a high Cronbach's alpha-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.

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Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.

R Matta (1996)

The results were reviewed for 259 patients who had open reduction and internal fixation of 262 displaced acetabular fractures within twenty-one days after the injury. Two hundred and fifty-five hips were followed for a mean of six years (range, two to fourteen years) after the injury; the remaining seven, which clearly had a poor result, were followed for less than two years. According to the classification of Letournel and Judet, associated fracture types accounted for 208 (79 per cent) of the fractures, with both-column fractures being the most common type (ninety-two hips; 35 per cent). Two hundred and fifty-eight hips were operated on with a single operative approach (Kocher-Langenbeck, ilioinguinal, or extended iliofemoral). The four remaining hips were operated on with a Kocher-Langenbeck as well as an ilioinguinal approach. The reduction was graded as anatomical in 185 hips (71 per cent). The rate of anatomical reduction decreased with increases in the complexity of the fracture, the age of the patient, and the interval between the injury and the reduction. The over-all clinical result was excellent for 104 hips (40 per cent), good for ninety-five (36 per cent), fair for twenty-one (8 per cent), and poor for forty-two (16 per cent). The clinical result was related closely to the radiographic result. The clinical result was adversely affected by associated injuries of the femoral head, an older age of the patient, and operative complications. It was positively affected by an anatomical reduction and postoperative congruity between the femoral head and the acetabular roof. Osteonecrosis of the femoral head was noted in eight hips (3 per cent), and progressive wear of the femoral head was seen in thirteen (5 per cent). Subsequent operations included a total replacement of seventeen hips (6 per cent), an arthrodesis in four (2 per cent), and excision of ectopic bone in twelve (5 per cent). These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.

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Author and article information

Contributors

Francesco Bosco:

ORCID: http://orcid.org/0000-0001-8306-1869

francesco.bosco532@edu.unito.it

Journal

Journal ID (nlm-ta): Eur J Orthop Surg Traumatol

Journal ID (iso-abbrev): Eur J Orthop Surg Traumatol

Title: European Journal of Orthopaedic Surgery & Traumatology

Publisher: Springer Paris (Paris )

ISSN (Print): 1633-8065

ISSN (Electronic): 1432-1068

Publication date (Electronic): 28 August 2023

Publication date PMC-release: 28 August 2023

Publication date (Print): 2024

Volume: 34

Issue: 1

Pages: 47-57

Affiliations

[1 ]Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, ( https://ror.org/048tbm396) Via Zuretti, 29, 10126 Turin, Italy

[2 ]GRID grid.415044.0, ISNI 0000 0004 1760 7116, Department of Orthopaedics and Traumatology, , Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, ; Turin, Italy

[3 ]Istituto Ortopedico del Mezzogiorno d’Italia “Franco Scalabrino”, Via Consolare Pompea, 98100 Messina, Italy

[4 ]Ortopedia Protesica e Robotica - Humanitas Gradenigo, Turin, Italy

[5 ]GRID grid.411075.6, ISNI 0000 0004 1760 4193, Department of Orthopaedics and Traumatology, , Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, ; Rome, Italy

[6 ]Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, ( https://ror.org/044k9ta02) Palermo, Italy

Author information

Francesco Bosco http://orcid.org/0000-0001-8306-1869

Article

Publisher ID: 3701

DOI: 10.1007/s00590-023-03701-z

PMC ID: 10771595

PubMed ID: 37640795

SO-VID: a2f4a915-f9cd-421b-9d24-4ae5722f3650

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 22 June 2023

Date accepted : 17 August 2023

Funding

Funded by: Università degli Studi di Torino

Open Access :

Open access funding provided by Università degli Studi di Torino within the CRUI-CARE Agreement.

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: combined hip procedure,chp,hip surgery,arthroplasty,acetabular fracture,tha,acute total hip arthroplasty,open reduction internal fixation

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: combined hip procedure, chp, hip surgery, arthroplasty, acetabular fracture, tha, acute total hip arthroplasty, open reduction internal fixation

Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review

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Orthopedics

Most cited references 42

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Methodological index for non-randomized studies (minors): development and validation of a new instrument.

Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.

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