Injury - 2026-04-09 - Journal Article
Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.
Mirahmadi A, Leland CR, Ibrahim IO, Rodriguez EK
Topics
Key Takeaway
Despite ORIF carrying higher 90-day mortality (5.2% vs 3.5%, OR 1.5) and acute THA carrying higher 2-year implant complication rates (PJI 6.8% vs 3.8%, instability 7.7% vs 3.0%), cumulative reoperation rates were statistically equivalent through 10 years (p=0.53 at 2 years).
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Summary
This multicenter retrospective cohort study used the TriNetX Network to compare ORIF versus acute primary THA for isolated closed acetabular fractures in adults, with 1:1 propensity score matching on demographics and comorbidities. ORIF carried higher 90-day mortality (5.2% vs 3.5%), stroke, VTE, respiratory failure, and ICU admission, while acute THA produced higher ED visits (9.1% vs 5.3%) and hip pain (23.2% vs 13.2%) at 90 days. Long-term, ORIF yielded 27.2% PTOA and 5.8% conversion to THA at 10 years, while acute THA produced higher periprosthetic fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), and instability (7.7% vs 3.0%) at 2 years, yet overall reoperation rates remained equivalent through 10 years.
Key Limitation
The TriNetX database cannot capture fracture morphology, displacement, or posterior wall involvement, meaning the two treatment groups likely represent fundamentally different fracture patterns that propensity matching on comorbidities alone cannot fully reconcile.
Original Abstract
BACKGROUND
Optimal management of acetabular fractures remains controversial. Open reduction and internal fixation (ORIF) may be followed by post-traumatic degeneration and late conversion arthroplasty, whereas acute total hip arthroplasty (THA) may introduce implant-related risks. We compared short- and long-term outcomes after ORIF versus acute THA in a large, multicenter electronic health record cohort.
METHODS
We performed a retrospective cohort study using the TriNetX Network. Adults with isolated, closed, acute acetabular fractures treated with either ORIF or acute primary THA were identified. Patients were propensity score-matched (PSM) 1:1 on demographics and comorbidities. Outcomes were assessed at 90 days and at 1, 2, 5, and 10 years, including mortality, complications, health care utilization, and procedure-specific failures (for
ORIF
nonunion, post-traumatic osteoarthritis, and conversion to THA; for
THA
periprosthetic fracture, prosthetic joint infection [PJI], instability/dislocation, and mechanical complications).
RESULTS
After PSM, 3700 matched pairs comprised the early follow-up cohorts. At 90 days, ORIF was associated with higher mortality (5.2% vs 3.5%; OR 1.5; p < 0.0001) and higher rates of stroke, respiratory failure, venous thromboembolism, and ICU admission, whereas acute THA had higher emergency department visits (9.1% vs 5.3%; p < 0.0001) and hip pain (23.2% vs 13.2%; p < 0.0001). Over long-term follow-up, acute THA demonstrated higher implant-related complications at 2 years, including periprosthetic/implant fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), instability (7.7% vs 3.0%), and mechanical complications (6.3% vs 3.5%) (all p < 0.0001), while overall reoperation rates were similar at 2 years (11.8% vs 11.2%; p = 0.53) and remained comparable through 10 years. In the ORIF cohort, nonunion reached 11.3%; conversion to THA increased from 4.3% at 2 years to 5.8% at 10 years; and post-traumatic osteoarthritis (PTOA) increased from 21.2% at 2 years to 27.2% at 10 years. Pre-index hip disease was markedly more common among acute THA patients (OA 51% vs 10%; AVN 14% vs 1%).
CONCLUSIONS
In this study, ORIF was associated with higher early mortality and systemic complications, whereas acute THA was associated with higher implant-related complications. Despite these differing complication profiles, cumulative reoperation rates were similar through long-term follow-up. Progressive PTOA and conversion to THA remain important sequelae after ORIF.