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- Title
Acute versus delayed total hip arthroplasty after acetabular fracture fixation: a systematic review and meta-analysis.
- Authors
Liang, Kaifeng; Gani, Muhammad Haseeb; Griffin, Xavier; Culpan, Paul; Mukabeta, Takura; Bates, Peter
- Abstract
Background: Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute total hip arthroplasty (THA), 'fix-and-replace', in patients considered to have a poor prognosis and likelihood of PTOA. Controversy remains between early fix-and-replace, versus delayed THA as required after initial ORIF. This systematic review included studies comparing functional and clinical outcomes between acute versus delayed THA after displaced acetabular fractures. Methods: Comprehensive searches following the PRISMA guideline were performed on six databases for articles in English published anytime up to 29 March 2021. Two authors screened articles and discrepancies were resolved by consensus. Patient demographics, fracture classification, functional and clinical outcomes were compiled and analysed. Results: The search yielded 2770 unique studies, of which five retrospective studies were identified with a total of 255 patients. Of them, 138 (54.1%) were treated with acute and 117 (45.9%) treated with delayed THA. Delayed THA group represented a younger cohort compared to the acute group (mean age, 64.3 vs 73.3). The mean follow-up time for the acute and delayed group was 23 and 50 months, respectively. There was no difference in functional outcomes between the two study groups. Complication and mortality rates were comparable. Delayed THA had a higher revision rate compared to the acute group (17.1 vs 4.3%; p = 0.002). Conclusion: Fix-and-replace had functional outcomes and complication rates similar to ORIF and delayed THA, but lower revision rates. Although the quality of studies was mixed, sufficient equipoise now exists to justify randomised studies in this area. PROSPERO registration: CRD42021235730
- Subjects
RISK of prosthesis complications; INFECTION risk factors; ONLINE information services; MEDICAL databases; INTERNAL fixation in fractures; TOTAL hip replacement; META-analysis; MEDICAL information storage &; retrieval systems; HIP osteoarthritis; CONFIDENCE intervals; SYSTEMATIC reviews; HIP fractures; OPEN reduction internal fixation; SURGICAL complications; EPIDEMIOLOGY; DISEASE incidence; TREATMENT delay (Medicine); TREATMENT effectiveness; RISK assessment; FRACTURE fixation; CRITICAL care medicine; ACETABULUM (Anatomy); DESCRIPTIVE statistics; REOPERATION; MEDLINE; DATA analysis software; STATISTICAL models; WOUNDS &; injuries; THERAPEUTIC complications; ODDS ratio; PERIPROSTHETIC fractures; DISEASE risk factors; EVALUATION
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2023, Vol 33, Issue 7, p2683
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-023-03489-y