Functional and radiological outcomes in elderly acetabular fracture patients treated with internal fixation and acute total hip arthroplasty

Purpose Acetabular fractures in elderly are associated with complex fracture patterns and poor bone quality. Internal fixation alone in these patients has been associated with poor outcome. Internal fixation combined with acute total hip arthroplasty (THA) is an approach to stabilize the acetabulum and restore hip function, however functional and radiological data are still limited. Methods Patients ≥ 60 years with an acetabular fracture treated with acute THA and additional acetabular fixation were followed up at least one year postoperatively. All patients were treated from 2017 to 2023 at the Karolinska University Hospital within 21 days after trauma. Medical records were reviewed, functional examinations and radiographic assessment were performed. Results A total of 32 patients were included. The median (IQR, range) age was 77 (35, 60–95) years and 22% (n = 7) were females. Dome impaction (94%, n = 30) was the main indication for THA and the median follow-up time was 3.1 years. Two (6%) patients had a postoperative hip dislocation. Three (9%) patients had a deep infection and 22% (n = 7) sustained at least one non-surgical complication. The median Harris Hip Score was 87 (33, 33.3–100) and the median EQ-5D-3L index score was 0.7 (0.5, 0.0–1.0). Heterotopic ossification was observed in 94% (n = 30) of the patients, mostly Brooker grade 1 (n = 18, 56%). No radiological signs of loosening of the acetabular reinforcement ring or the cup was observed. Conclusions Internal fixation with acute THA among elderly may yield a good functional outcome with no signs of acetabular implant loosening in this mid-term follow-up.