Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in:

Open Access 01-12-2024 | Systematic Review

Risk factors for acetabular fracture treatment failure: a systematic review and meta-analysis

Authors: Sina Esmaeili, Farhad Shaker, Amirhossein Ghaseminejad-Raeini, Mohammadjavad Baghchi, Seyyed Mobin Sajadi, Seyyed Hossein Shafiei

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

Login to get access

Abstract

Introduction

Acetabular fractures can lead to persistent pain and disability. Managing these complex injuries involves several treatment options such as nonoperative methods, percutaneous fixation, open reduction internal fixation (ORIF), and total hip arthroplasty (THA), and various combinations of these techniques. Around 20 to 40% of patients treated with ORIF may develop post-traumatic arthritis requiring THA. To pinpoint the factors contributing to initial treatment failure of acetabular fractures and the subsequent need for THA conversion, we are conducting a systematic review of relevant literature.

Methods

A thorough search of PubMed, Scopus, Web of Science, and Embase databases yielded studies investigating risk factors linked to the conversion of acetabular fracture treatment to THA. Inclusion criteria were employed, and data extraction, as well as quality assessment, were conducted by two reviewers. Utilizing R software, meta-analyses were conducted employing the Mantel-Haenszel method. Random-effect models were employed when the I2 was greater than 50% (Heterogeneous data). A P-value less than 0.05 is considered statistically significant.

Results

In this systematic review involving 25 pertinent studies, our analysis unveiled significant risk factors contributing to the conversion from initial acetabular fracture treatment to THA. Notable factors included advanced age (SMD [95%CI] = 0.43 [0.17–0.69]), female gender (OR [95%CI] = 1.65 [1.15–2.38]), posterior wall involvement (OR [95%CI] = 1.81 [1.32–2.47]), acetabular impaction (OR [95%CI] = 3.23 [1.99–5.25]), femoral impaction (OR [95%CI] = 6.08 [3.35–11.05]), and femoral head dislocation (OR [95%CI] = 3.94 [2.02–7.70]). Associated fracture type exhibited no significant link to the risk of conversion to THA.

Conclusion

Recognizing these factors allows for the adjustment of patient expectations, providing them with information about the potential necessity of THA in the future. Patients exhibiting these risk factors may derive greater benefits from treatment administered by experienced surgeons.
Appendix
Available only for authorised users
Literature
1.
Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–45.PubMedCrossRef
2.
Boraiah S, Ragsdale M, Achor T, Zelicof S, Asprinio DE. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma. 2009;23(4):243–8.PubMedCrossRef
3.
Enocson A, Blomfeldt R. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma. 2014;28(6):330–7.PubMedCrossRef
4.
Herscovici D Jr., Lindvall E, Bolhofner B, Scaduto JM. The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly. J Orthop Trauma. 2010;24(5):291–6.PubMedCrossRef
5.
Sierra RJ, Mabry TM, Sems SA, Berry DJ. Acetabular fractures: the role of total hip replacement. Bone Joint J. 2013;95–b(11 Suppl A):11–6.PubMedCrossRef
6.
Wu ES, Jauregui JJ, Banerjee S, Cherian JJ, Mont MA. Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture. Expert Rev Med Devices. 2015;12(3):297–306.PubMedCrossRef
7.
Cahueque M, Martínez M, Cobar A, Bregni M. Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis? J Clin Orthop Trauma. 2017;8(4):320–6.PubMedPubMedCentralCrossRef
8.
O’Toole RV, Hui E, Chandra A, Nascone JW. How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty? J Orthop Trauma. 2014;28(3):148–53.PubMedCrossRef
9.
Khurana S, Nobel TB, Merkow JS, Walsh M, Egol KA. Total hip arthroplasty for posttraumatic osteoarthritis of the hip fares worse than THA for primary osteoarthritis. Am J Orthop (Belle Mead NJ). 2015;44(7):321–5.PubMed
10.
Boelch SP, Jordan MC, Meffert RH, Jansen H. Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int Orthop. 2017;41(9):1831–7.PubMedCrossRef
11.
Shaker F, Esmaeili S, Nakhjiri MT, Azarboo A, Shafiei SH. The outcome of conversion total hip arthroplasty following acetabular fractures: a systematic review and meta-analysis of comparative studies. J Orthop Surg Res. 2024;19(1):83.PubMedPubMedCentralCrossRef
12.
von Roth P, Abdel MP, Harmsen WS, Berry DJ. Total hip arthroplasty after operatively treated acetabular fracture: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2015;97(4):288–91.CrossRef
13.
Schnaser E, Scarcella NR, Vallier HA. Acetabular fractures converted to total hip arthroplasties in the elderly: how does function compare to primary total hip arthroplasty? J Orthop Trauma. 2014;28(12):694–9.PubMedCrossRef
14.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.PubMedPubMedCentralCrossRef
15.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Reviews. 2016;5(1):210.CrossRef
16.
Wells G, Shea B, O’Connell D, Peterson j, Welch V, Losos M, Tugwell P. The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. ᅟ 2000, &#4447.
17.
18.
Nikolakopoulou A, Mavridis D, Salanti G. How to interpret meta-analysis models: fixed effect and random effects meta-analyses. Evid Based Ment Health. 2014;17(2):64.PubMedCrossRef
19.
Henry PDG, Si-Hyeong Park S, Paterson JM, Kreder HJ, Jenkinson R, Wasserstein D. Risk of hip Arthroplasty after Open Reduction Internal fixation of a fracture of the Acetabulum: a matched cohort study. J Orthop Trauma. 2018;32(3):134–40.PubMedCrossRef
20.
Dunet B, Tournier C, Billaud A, Lavoinne N, Fabre T, Durandeau A. Acetabular fracture: long-term follow-up and factors associated with secondary implantation of total hip arthroplasty. Orthop Traumatol Surg Res. 2013;99(3):281–90.PubMedCrossRef
21.
Borg T, Hailer NP. Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients. Arch Orthop Trauma Surg. 2015;135(2):227–33.PubMedCrossRef
22.
Chen CY, Hsu CJ, Lin TL, Chen HT, Tsai CH. Acetabular fractures with central hip dislocation: a retrospective consecutive 50 case series study based on AO/OTA 2018 classification in midterm follow-up. Biomed Res Int 2021, 2021:6659640.
23.
Firoozabadi R, Hamilton B, Toogood P, Routt MC, Shearer D. Risk factors for Conversion to Total Hip Arthroplasty after Acetabular fractures involving the posterior wall. J Orthop Trauma. 2018;32(12):607–11.PubMedCrossRef
24.
Clarke-Jenssen J, Røise O, Storeggen S, Madsen JE. Long-term survival and risk factors for failure of the native hip joint after operatively treated displaced acetabular fractures. Bone Joint J 2017, 99–b(6):834–840.
25.
Gänsslen A, Hildebrand F, Kretek C. Transverse + posterior wall fractures of the acetabulum: epidemiology, operative management and long-term results. Acta Chir Orthop Traumatol Cech. 2013;80(1):27–33.PubMedCrossRef
26.
Hayes PJ, Carroll CM, Roberts CS, Seligson D, Lau E, Kurtz S, Ong K, Malkani AL. Operative treatment of acetabular fractures in the Medicare population. Orthopedics. 2013;36(8):e1065–1070.PubMedCrossRef
27.
Huebner K, McTague MF, Allen E, Diwan A, Smith RM. The direct posterior gluteal muscle splitting approach for posterior access to acetabular fractures: Surgical technique and case series. Injury. 2022;53(8):2810–7.PubMedCrossRef
28.
Khoshbin A, Hoit G, Henry PDG, Paterson JM, Huang A, Atrey A, Kreder HJ, Jenkinson R, Wasserstein D. Risk of total hip Arthroplasty after Acetabular fracture fixation: the importance of age. J Arthroplasty. 2021;36(9):3194–e31993191.PubMedCrossRef
29.
Kiran M, Frostick R, Elnahal W, Spence D, Acharya M, Ward A, Chesser TJ. The fate of acetabular fracture fixation at 10 years: rates of conversion to arthroplasty. Hip Int. 2023;33(6):1086–92.PubMedCrossRef
30.
Lai PJ, Lai CY, Tseng IC, Su CY, Yu YH. Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures. BMC Musculoskelet Disord. 2022;23(1):830.PubMedPubMedCentralCrossRef
31.
Lin SY, Ho CJ, Liu WC, Chen JK, Tu HP, Lee TC, Chang JK, Chen CH, Lu CC. Predicting the Poor Clinical and Radiographic outcomes after the anatomical reduction and internal fixation of posterior Wall Acetabular fractures: a retrospective analysis. J Clin Med 2022, 11(11).
32.
Meesters AML, Oldhoff MGE, Trouwborst NM, Assink N, Kraeima J, Witjes MJH, de Vries JPM, Ten Duis K. FFA IJ: quantitative three-dimensional measurements of Acetabular fracture displacement could be predictive for native hip survivorship. J Pers Med 2022, 12(9).
33.
Nicholson JA, Scott CEH, Annan J, Ahmed I, Keating JF. Native hip dislocation at acetabular fracture predicts poor long-term outcome. Injury. 2018;49(10):1841–7.PubMedCrossRef
34.
Poletti PA, Sahin M, Peter R, Boudabbous S, Herpe G, Rutschmann OT, Platon A. Femoral head subchondral impaction on CT: what does it mean in patients with acetabular fracture? Skeletal Radiol. 2019;48(6):939–48.PubMedCrossRef
35.
Preston G, Heimke IM, Heindel K, Scarcella NR, Furdock R, Vallier HA. Survivorship of the Hip Joint after Acetabulum fracture. J Am Acad Orthop Surg. 2021;29(18):781–8.PubMed
36.
Rollmann MF, Holstein JH, Pohlemann T, Herath SC, Histing T, Braun BJ, Schmal H, Putzeys G, Marintschev I, Aghayev E. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. Int Orthop. 2019;43(9):2167–73.PubMedCrossRef
37.
Strom S, Mihas AK, Bonner HV, Cichos KH, McGwin G, Patch DA, Agarwal A, Spitler CA. Risk factors for deep infection and Conversion Total Hip Arthroplasty after Operative Combined Pelvic Ring and Acetabular fractures. J Orthop Trauma. 2022;36(11):573–8.PubMedCrossRef
38.
Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012;94(17):1559–67.PubMedCrossRef
39.
Verbeek DO, van der List JP, Villa JC, Wellman DS, Helfet DL. Postoperative CT is Superior for Acetabular Fracture Reduction Assessment and reliably predicts hip survivorship. J Bone Joint Surg Am. 2017;99(20):1745–52.PubMedCrossRef
40.
Verbeek DO, van der List JP, Helfet DL. Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship. Arch Orthop Trauma Surg. 2019;139(12):1667–72.PubMedPubMedCentralCrossRef
41.
Verbeek DO, van der List JP, Tissue CM, Helfet DL. Predictors for long-term hip survivorship following Acetabular fracture surgery: importance of gap compared with step displacement. J Bone Joint Surg Am. 2018;100(11):922–9.PubMedCrossRef
42.
Zanna L, Ceri L, Scalici G, Boncinelli D, Burchette DT, Buzzi R, De Biase P. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty. Eur J Orthop Surg Traumatol. 2023;33(6):2419–26.PubMedCrossRef
43.
Henry PD, Kreder HJ, Jenkinson RJ. The osteoporotic acetabular fracture. Orthop Clin North Am. 2013;44(2):201–15.PubMedCrossRef
44.
Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res 2003(407):173–86.
45.
Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92(2):250–7.PubMedCrossRef
46.
Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T. Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma. 2000;14(4):230–7.PubMedCrossRef
47.
Yue JJ, Sontich JK, Miron SD, Peljovich AE, Wilber JH, Yue DN, Patterson BM. Blood flow changes to the femoral head after acetabular fracture or dislocation in the acute injury and perioperative periods. J Orthop Trauma. 2001;15(3):170–6.PubMedCrossRef
48.
Liebergall M, Mosheiff R, Low J, Goldvirt M, Matan Y, Segal D. Acetabular fractures. Clinical outcome of surgical treatment. Clin Orthop Relat Res. 1999;366:205–16.CrossRef
49.
Ding A, OʼToole RV, Castillo R, Reahl B, Montalvo R, Nascone JW, Sciadini MF, Carlini AR, Manson TT. Risk factors for early reoperation after operative treatment of Acetabular fractures. J Orthop Trauma. 2018;32(7):e251–7.PubMedCrossRef
50.
Shah SB, Manson TT, Nascone JW, Sciadini MF, O’Toole RV. Radiographic determinants of early failure after posterior Wall Acetabular fracture fixation. Orthopedics. 2016;39(6):e1104–11.PubMedCrossRef
51.
Meena UK, Tripathy SK, Sen RK, Aggarwal S, Behera P. Predictors of postoperative outcome for acetabular fractures. Orthop Traumatol Surg Res. 2013;99(8):929–35.PubMedCrossRef
52.
Smakaj A, Rovere G, Scoscina D, De Mauro D, Erasmo R, Battiato C, Maccauro G, Liuzza F. Outcomes of acetabular fractures treated with acute fix and replace versus open reduction and internal fixation in elderly population: a multicentric retrospective study. Int Orthop. 2022;46(11):2659–66.PubMedCrossRef
53.
De Mauro D, Rovere G, Are L, Smakaj A, Aprato A, Mezzadri U, Bove F, Casiraghi A, Marino S, Ciolli G et al. Spring plates as a valid additional fixation in comminuted posterior Wall Acetabular fractures: a retrospective Multicenter Study. J Clin Med 2023, 12(2).
54.
Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005;87(1):2–9.PubMedCrossRef
55.
56.
Butler BA, Hannan ZD, Ghulam QM, DeLeon GA, O’Hara N, Nascone JW, Sciadini MF, O’Toole RV. The Effect of Surgeon Experience on Short- to medium-term complication rate following operative fixation of Acetabular fractures. J Orthop Trauma. 2022;36(10):509–14.PubMedCrossRef
Metadata
Title
Risk factors for acetabular fracture treatment failure: a systematic review and meta-analysis
Authors
Sina Esmaeili
Farhad Shaker
Amirhossein Ghaseminejad-Raeini
Mohammadjavad Baghchi
Seyyed Mobin Sajadi
Seyyed Hossein Shafiei
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-08114-5

Other articles of this Issue 1/2024

Investıgatıon of the effects of treatment with enoxaparın sodıum and hyperbarıc oxygen therapy on the recovery of rats wıth achılles tendon rupture

Synovial hemangioma presenting with chronic painful infrapatellar mass: a case report

Evaluation of the clinical efficacy of using an inverted triangular cannulated compression screw in combination with positive or negative buttress reduction for the healing of femoral neck fractures

Optimal reimplantation timing in two-stage exchange for periprosthetic joint infection: an observative cohort study in Asian population

Clinical outcome after open-wedge high tibial osteotomy: comparison of double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP)

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture