Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

Julio J Jauregui; Tristan B Weir; Jin F Chen; Aaron J Johnson; Neil R Sardesai; Aditya V Maheshwari; Theodore T Manson

doi:10.1016/j.jcot.2020.01.003

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

J Clin Orthop Trauma. 2020 Nov-Dec;11(6):976-982. doi: 10.1016/j.jcot.2020.01.003. Epub 2020 Jan 9.

Authors

Julio J Jauregui¹, Tristan B Weir¹, Jin F Chen², Aaron J Johnson¹, Neil R Sardesai¹, Aditya V Maheshwari², Theodore T Manson¹

Affiliations

¹ R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
² Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Abstract

Objective: Multiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.

Methods: Meta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17-97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.

Results: Weighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.

Conclusions: Acute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.

Keywords: Acetabular fractures; Geriatric patients; HO, heterotopic ossification; MINORS, Methodological Index for Non-Randomized Studies; ORIF, open reduction and internal fixation; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analyses; THA, total hip arthroplasty; Total hip arthroplasty; VTE, venous thromboembolic event.