SIMULTANEOUS “FIX AND REPLACE” HAS NONINFERIOR SURVIVORSHIP COMPARED WITH STAGED ARTHROPLASTY IN ACETABULAR FRACTURE MANAGEMENT IN MEDIUM-TERM FOLLOW-UP

In an increasingly frail population, simultaneous “fix and replace” surgery (fixation of the acetabulum to accommodate a press fit cup and total hip arthroplasty (THA)) is a novel alternative to open reduction and internal fixation (ORIF) alone in the management of acetabular fractures. We aimed to determine whether patients managed with “fix and replace” have comparable survivorship to those undergoing staged THA following previous open reduction and internal fixation for acetabular fracture. All Patients with acetabular fractures surgically managed within a Scottish Tertiary centre over a five year period (01/01/2018-30/05/2023) were identified. Thirty-four patients underwent “fix and replace” surgery and 133 underwent acetabular ORIF alone. Twenty-one of these patients subsequently required staged THA (6%). Follow up mean was 2.7 years (SD +/-1.7) for “fix and replace” versus 3.3 years (SD +/- 1.5) for staged THA. There was no statistical significance between the two groups with regards to BMI or sex. The fix and replace group were older (p=0.001), had higher ASA (p=0.006) and CCI (p=0.027), respectively. High energy mechanism of injury accounted for 56% of the “fix and replace” group compared to 48% in the ORIF to THA. 74% of “fix and replace” were associated/complex fractures (LeTournel) compared to 53% of staged THA. Mean wait to surgery was 3 days in the “fix and replace” group compared to 186 days from listing to operation in the staged THA group. Survival analysis demonstrated acceptable results for both groups at four years year with Fix and Replace 86% at one year and 76% survival in the staged THA group (p=0.13). Complications were comparable in both groups (41% versus 43%, p value= 0.58). In our experience “fix and replace” is an option for the elderly, co-morbid patient with an acetabular fracture to enable early weightbearing with acceptable survivorship compared to staged THA.