Outcomes of THA versus ORIF for Acetabular Fractures in Older Adults

Document Type

Journal Article

Publication Date

8-1-2025

Journal

Journal of orthopaedic trauma

DOI

10.1097/BOT.0000000000003052

Keywords

ORIF; THA; acetabular fracture; national database

Abstract

OBJECTIVES: To compare outcomes of total hip arthroplasty (THA) versus open reduction internal fixation (ORIF) for acetabular fractures in older adults using a large national database. METHODS: Design: Retrospective cohort study using the Medicare Limited Data set. SETTING: 798 acute short-stay hospitals. PATIENT SELECTION CRITERIA: Fee-for-service Medicare beneficiaries aged 65+ who underwent inpatient ORIF or THA for acetabular fractures (OTA/AO 62) (without associated femoral fractures) from January 2013 to December 2020 were included. OUTCOME MEASURES AND COMPARISONS: To minimize confounding, 1 THA patient was matched with up to 2 ORIF patients based on sociodemographic factors, comorbidities, and surgery year using a propensity score approach. Multivariable generalized linear models identified adjusted associations between surgery type and outcomes; adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CI) were reported. RESULTS: Among 5,656 eligible procedures, the matched cohort included 2,879 patients (1,027 THA, mean age 78.6, 42.3% male; 1,852 ORIF, mean age 78.6, 42.4% male). THA (versus ORIF) patients had an increased odds of 30-day and 90-day hospital returns (30-day: OR=1.54, P<0.001; 90-day: OR=1.25, P=0.01) as well as 90-day and 1-year infection (90-day: OR=1.92, P<0.001; 1-year: OR=1.74, P<0.001). THA was also associated with higher odds of 90-day reoperation (OR=2.47, P<0.001) but not 1-year reoperation (OR=0.84, P=0.16). No significant associations were observed for hospital length of stay (P=0.42), discharge disposition (P=0.93), use of 90-day home health services (P=0.13), 90-day venous thromboembolism (P=0.75), or 1-year mortality (P=0.65). CONCLUSIONS: Patients who underwent THA for acetabular fractures were more likely to return to the hospital within 30 and 90 days post-surgery, have an infection in the year after surgery, and undergo a reoperation in the 90-day postoperative period compared to those who underwent ORIF. Further investigation of the mechanisms of the observed associations is necessary to understand which surgical approach provides optimal outcomes. LEVEL OF EVIDENCE: Level III.

Department

School of Medicine and Health Sciences Student Works

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