The purposes of this study were to determine the rate of failure of the hip joint after acetabulum fracture and to identify risk factors.
Acetabulum fractures treated over 17 years at a level-1 trauma center were reviewed. Patient, injury, and treatment factors were assessed regarding possible association with failure of the hip joint: end-stage arthrosis and/or total hip arthroplasty (THA).
Seventy percent were treated with primary open reduction and internal fixation (ORIF). Seventy-two (12.5%) of 575 fractures underwent THA; 64 were after initial ORIF. The mean follow-up was 80 months, and the median time to THA was 14 months (range 10-200 months). Age, body mass index, fracture type, marginal impaction, and hip dislocations were independent predictors of hip joint failure. The mean injured age of THA patients was 53 versus 43 (P < 0.001). T-type fractures were most likely to fail (21% within 2 years, 45% within 10 years, P = 0.001). Other injury features: marginal impaction and posterior hip dislocation were associated with failure with odds ratios 2.79 and 1.73, respectively (P < 0.001).
Eighty-five percent of native hips survived; the median time to THA was 14 months. Most who had THA had initial posterior fracture-dislocations. Older age, elevated body mass index, T-type pattern, marginal impaction, and hip dislocation increase the likelihood of hip joint failure.