No Difference in Acute Outcomes for Patients Undergoing Fix and Replace Versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures.

Objectives: To compare acute outcomes between patients undergoing fix and replace (FaR) versus open-reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures.
Design: Retrospective Cohort Study.
Setting: Single Level 2 Trauma Center.
Patient Selection Criteria: Consecutive acetabular fracture patients ≥ 55 years of age treated by two orthopaedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR versus ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty.
Outcome Measures and Comparisons: The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and preoperative and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups.
Results: Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6-75.6 months). More FaR group patients were ordered immediate weight-bearing as tolerated or partial weight-bearing compared with ORIF alone (70% vs. 9.0%, P = 0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared with ORIF alone (71% vs. 27%, P = 0.05). Fracture classification ( P = 0.03) and Charlson Comorbidity Index ( P = 0.02) differed between the 2 groups. There were no other differences in demographics, LOS ( P = 0.99), postoperative disposition ( P = 0.54), time to postoperative mobilization ( P = 0.38), 90-day readmission rates ( P = 0.51), operative time ( P = 0.06), radiographic union ( P = 0.35), time to union ( P = 0.63), pre- ( P = 0.32) or postoperative HOOS Jr. scores ( P = 0.80), delta HOOS Jr. scores ( P = 0.28), or reoperation rates between groups ( P = 0.15).
Conclusions: FaR and ORIF seem to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weight-bearing earlier than the ORIF group; however, time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: The authors report no conflict of interest. All authors declare no direct conflicts of interest in connection with the current work. However, interests outside of the current work that may be perceived as influencing the representation or interpretation of the reported results are reported by authors: I.S. Hong: LifeNet Health: Paid biostatistical consultant. R.S. Yoon: American Association of Hip and Knee Surgeons: Board or committee member, Arthrex, Inc: IP royalties; Paid consultant, Bicomposites: Research support, Biomet: Research support, COTA: Research support, DePuy, A Johnson & Johnson Company: Paid consultant, Foundation for Physician Advancement: Board or committee member, Foundation of Orthopaedic Trauma: Board or committee member, LifeNet Health: Paid consultant; Research support, MiCare Health: Paid consultant, OMEGA: Research support, Organogenesis: Research support, ORintelligence: Stock or stock Options, OrthoGrid: Paid consultant, Orthopaedic Trauma Association: Board or committee member, ORTHOXEL: Paid consultant, Pacira: Research support, SI Bone: Research support, SI-Bone: Paid consultant, Smith & Nephew: Research support, Springer: Publishing royalties, financial or material support, Stryker: IP royalties; Paid consultant, Synthes: Paid consultant; Research support, Use-Lab: Paid consultant, WNT Scientific: Stock or stock Options. F.A. Liporace: AAOS: Board or committee member, AO: Unpaid consultant, Biomet: IP royalties; Paid consultant; Paid presenter or speaker; Research support, DePuy, A Johnson & Johnson Company: IP royalties; Research support, Orthopaedic Trauma Association: Board or committee member, Stryker: IP royalties, Synthes: Paid consultant; Paid presenter or speaker.
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