JOA - 2026-06-01 - Journal Article; Systematic Review; Meta-Analysis
To Fix or Replace? A Systematic Review and Meta-Analysis on Surgical Management of Acetabular Fractures in the Elderly.
Brady TT, Bera SR, Grammatopoulos G, Adamczyk AP
Topics
Key Takeaway
In patients ≥60 years with acetabular fractures, acute THA/CHP reduced reoperation risk 2.6-fold compared to ORIF (RR 2.60; 95% CI 1.42–4.75) and yielded Harris Hip Scores 6.11 points higher at 1–2 years.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review and meta-analysis compared ORIF versus acute THA/CHP for acetabular fractures in patients ≥60 years across 13 comparative studies. ORIF patients were significantly younger (MD −4.14 years) and had lower ASA scores, introducing substantial selection bias. Despite this, ORIF carried a 2.6-fold higher reoperation rate (84% of which were conversion THA for posttraumatic OA at median 14.7 months) and inferior Harris Hip Scores at 1–2 years (MD −6.11 points).
Key Limitation
Systematic selection bias: ORIF patients were 4 years younger with lower ASA scores, meaning the two groups are not clinically equivalent and the apparent superiority of THA/CHP may reflect patient selection rather than treatment effect.
Original Abstract
BACKGROUND
Acetabular fractures in the elderly are increasingly common and associated with high morbidity and mortality. Although open reduction and internal fixation (ORIF) has been the mainstay of treatment, elderly outcomes have been less consistent. Acute total hip arthroplasty (THA), with or without fixation (combined hip procedure, CHP), is an alternative approach that may facilitate earlier mobilization and reduce early reoperation. This systematic review and meta-analysis compared outcomes of ORIF versus acute THA/CHP for acetabular fractures in patients aged 60 years and older.
METHODS
A systematic review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched from 2000 to the present. Comparative studies reporting outcomes for ORIF and THA/CHP in patients aged ≥ 60 years were included. Reviewers independently screened and extracted data on demographics, interventions, complications, functional outcomes, and patient-reported outcome measures. Pooled incidence rates, risk ratios (RRs), and mean differences (MDs) were calculated using random-effects models. There were 13 studies and 949 patients (ORIF: 620;
THA/CHP
329) included. The pooled mean age was 74 years (range, 60 to 93). The ORIF patients were younger (MD: -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02).
RESULTS
Reoperation was more common after ORIF (RR: 2.60; 95% confidence interval [CI]: 1.42 to 4.75; P = 0.002), with 84% of conversions due to posttraumatic osteoarthritis. The median time to conversion THA was 14.7 months. The post traumatic osteoarthritis incidence was 34% following ORIF; dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores at one to 2 years postoperatively were higher in the arthroplasty group (MD -6.11; 95% CI: -9.90 to -2.31; P = 0.002).
CONCLUSIONS
Acute THA/CHP may offer a viable treatment option in the elderly, demonstrating lower reoperation rates and improved function compared to ORIF.