Acetabular fracture open reduction and internal fixation in patients under 60: time to total hip arthroplasty and implant survivorship: a systematic review.

AIMS: Acetabular fractures in young patients are usually treated with open reduction and internal fixation (ORIF) to preserve the native joint. Despite this, many develop post-traumatic arthritis, needing conversion to total hip arthroplasty (THA). The timing of THA and the long-term survival of these implants remain uncertain. We systematically reviewed the literature to determine the interval from ORIF to THA and to evaluate implant survivorship.

METHODS: We searched PubMed, Embase, Scopus, and Web of Science for studies reporting outcomes of patients <60 years who underwent ORIF for acetabular fracture and later THA. Data extracted on patient demographics, fracture type, time to THA, survivorship, and complications. Pooled estimates were calculated using random-effects models, and survivorship summarised using Kaplan-Meier methods.

RESULTS: 12 studies including, ~450 patients met inclusion criteria. The pooled mean time from ORIF to THA was approximately 5.2 years (95% CI, 3.7-6.6). Between a ¼ and ⅓ of patients required THA at longer follow-up. Implant survivorship was 95% at 5 years and 85-90% at 10 years, declining to 70-80% at 15 years. Outcomes were worse in complex fracture patterns. Cementless fixation and modern porous ingrowth cups achieved survivorship similar to primary THA. Complications were more common than in primary THA, including dislocation (~10%), infection (~7%), and reoperation (~15%).

CONCLUSIONS: In patients under 60, ORIF usually delays the need for THA by several years, but conversion is required in a substantial population. Conversion THA restores function and achieves acceptable survivorship, although it remains technically demanding, with higher complication rates than primary THA.