Patients Aged 60 or Older with Surgically Treated Periprosthetic Acetabular Fractures Are at Similar Risk of Death at One Year Compared to Native Acetabular Fractures

<b>Background/Objectives:</b> Periprosthetic acetabular fractures in older adults are rare compared to other fractures of the hip. Nevertheless, their incidence is increasing due to an aging population with a growing number of total hip arthroplasties. Surgical management is complex, often involving frail patients, and one might expect an elevated risk of postoperative mortality. This study aimed to (1) determine the one-year mortality rate after operative treatment and (2) assess the perioperative complication rate of periprosthetic compared to native acetabular fractures. <b>Methods:</b> We identified 136 surgically treated acetabular fractures in patients ≥ 60 years (2012-2019): 31 periprosthetic and 105 native fractures. We performed case-control matching based on gender, frailty, osteoporosis, and comorbidities, yielding two matched cohorts (31 per group). (1) All patients were contacted, and the one-year mortality was assessed with Kaplan-Meier survivorship analysis before and after matching. (2) The perioperative complication rate was graded according to Sink. <b>Results:</b> (1) One-year mortality was 10% in the periprosthetic group vs. 20% in the native group (<i>p</i> = 0.19). After matching, no significant difference in the mortality rate was observed (10% vs. 23%, <i>p</i> = 0.17). (2) Overall complication rates were 61% in the periprosthetic group and 70% in the native group (<i>p</i> = 0.39). <b>Conclusions:</b> We observed a one-year mortality rate for periprosthetic acetabular fractures that was comparable to that of native acetabular fractures.