Acute Total Hip Arthroplasty with or Without Internal Fixation for Acetabular Fractures in the Elderly: A Case Series

<i>Background and Objectives</i>: Acetabular fractures in elderly patients are increasing in incidence and are frequently associated with osteoporotic bone, fracture comminution, marginal impaction, and pre-existing joint degeneration. Open reduction and internal fixation (ORIF) alone in this population is associated with high rates of fixation failure, post-traumatic osteoarthritis, and secondary conversion to total hip arthroplasty (THA). Acute THA, with or without concomitant internal fixation, has emerged as an alternative strategy aimed at enabling early mobilization and reducing reoperation rates. <i>Materials and Methods</i>: We retrospectively reviewed a series of elderly patients who sustained an acetabular fracture and were treated with acute THA, either as a standalone procedure or combined with internal fixation. Demographic data, fracture patterns, surgical technique, implant choice, complications, and short-term clinical and radiographic outcomes were analyzed. <i>Results</i>: Acute THA allowed immediate or early weight bearing in all patients. Implant stability was achieved using a highly porous, multi-hole acetabular component with supplemental screw fixation and selective use of internal fixation to restore columnar stability when required. Complications were comparable to those reported in the contemporary literature for acute THA in acetabular fractures. <i>Conclusions</i>: In carefully selected elderly patients with acetabular fractures at high risk of failure after ORIF, acute THA with or without internal fixation represents a viable definitive treatment strategy, enabling early mobilization and avoiding the morbidity associated with delayed salvage arthroplasty.