Simultaneous “fix and replace” has non inferior survivorship compared to staged arthroplasty in acetabular fracture management at two year follow up

Aims: In an increasingly frail population, simultaneous “fix and replace” surgery (fixation of the acetabulum to accommodate a press fit cup and total hip arthroplasty (THA)) is a novel alternative to open reduction and internal fixation (ORIF) alone in the management of acetabular fractures. We aimed to determine whether patients managed with “fix and replace” have comparable survivorship to those undergoing staged THA following previous open reduction and internal fixation for acetabular fracture.

Methods: All Patients with acetabular fractures surgically managed within our Tertiary centre over a five year period (01/01/2018–30/05/2023) were identified. Thirty-four patients underwent simultaneous “fix and replace” surgery and 133 underwent acetabular ORIF alone. Twenty-one of these patients required staged THA (6 %).

Results: Follow up mean was 2.7 years (SD ±1.7) for 'fix and replace' versus 3.3 years (SD ± 1.5) for staged THA. There was no statistically significant difference between the two groups with regards to BMI or sex. The fix and replace group were older (p = 0.001), had higher American Society of Anesthesiologists (ASA) grade (p = 0.006) and Charlson Comorbidity Index (CCI) (p = 0.027), respectively. High energy mechanism of injury accounted for 56 % of the "fix and replace" group compared to 48 % in the ORIF to THA. 74 % of 'fix and replace' were associated/complex fractures (LeTournel) compared to 53 % of staged THA. Mean wait to surgery was 3 days in the 'fix and replace' group compared to 186 days from listing to operation in the staged THA group. Survival analysis demonstrated acceptable results for both groups with greater than 85 % survival at 2 years and no statistical significantly worse survivorship in the 'fix and replace' group (p = 0.13). Complications were comparable in both groups (41 % versus 43 %, p = 0.58).

Conclusions: 'Fix and replace' is a good option for the elderly, co-morbid patient. It enables early weight bearing and has acceptable survivorship compared to staged THA following acetabular ORIF.