Survivorship of hip after acetabulum fracture fixation - Analysing risk factors associated with early THR.

Introduction: Acetabular fracture fixation principles stated by Letournel and Judet have contributed significantly towards advancement in treatment methodologies. Current day techniques helps to achieve anatomical reduction, still post-traumatic arthritis ensues in some patients. A meta-analysis by Giannoudis et al. revealed osteoarthritis incidence of 13 % in patients with satisfactory reductions (<2 mm) and 44 % with unsatisfactory reductions (>2 mm). Predicting poor outcomes before treatment could improvise patient counselling and treatment selection. This study aims to assess the functional outcomes and analyze risk factors for early total hip replacement (THR) in acetabulum fractures.

Materials And Methods: From 2017 to 2024, 560 patients with acetabulum fractures were managed surgically. Out of them 316 had more than 2 years follow up, and were included in this study. Fracture patterns involved 5 elementary and 5 associated types, treated through various surgical approaches and followed up for an average of 3 years. Data collection included demographics, lab investigations, radiographs, and CT scans. Statistical analysis using SPSS version 29.0.2.0 employed Chi-square tests, Fisher's exact tests and Cox proportional hazards regression to identify significant predictors of THR, with P-values <0.05 considered significant.

Results: The study involved 316 patients, with a mean age of 43 years, followed up for 2-7 years. 81 % were males. Most fractures were T-type (17.1 %) and treated using the Modified Stoppa Approach (43.7 %). Anatomic reduction was achieved in 77.2 % patients. Overall, 75.3 % patients had excellent to good outcomes. 32 (10.12 %) of the patients were converted to THR, while 46 (14.5 %) had fair outcomes, and were considered as cases of impending THR. Significant predictors for THR included age, surgical delay, fracture pattern and reduction quality. Age 60 and above, and poor reduction quality were associated with higher THR rates (Hazard ratio = 1.00).

Conclusion: Survivorship of the hip joint post-acetabulum fracture is influenced by age, fracture pattern, surgical delay, and post operative reduction quality. Addressing modifiable factors such as anatomical reductions of the fracture and surgical intervention within one week of injury are crucial for improving long-term outcomes, further reducing the need for THR after acetabular fracture fixation.