Tannast (2012) — Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures.

Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

·J Bone Joint Surg Am·2012·429 citations·Trauma

This retrospective cohort study reports Kaplan-Meier survivorship of the native hip joint in 816 displaced acetabular fractures treated with ORIF by a single high-volume surgeon over 26 years, using conversion to THA or arthrodesis as the endpoint. Multivariate Cox regression identifies independent predictors of failure and a nomogram predicts individual probability of early THA need.

Study Snapshot

Design

Retrospective cohort

Setting: Single center, Santa Monica

Funding: Swiss National Science Foundation

Objective

Determine whether ORIF of acetabular fractures preserves native hip long-term

Outcome(s)

Cumulative hip survivorship (conversion to THA or arthrodesis) at 20 years

Subjects

816 hips (810 patients), operatively treated acetabular fractures

Inclusion

Displaced acetabular fracture treated with ORIF
Minimum 2 years follow-up

Exclusion

Nonoperative treatment (n=87)
Acute primary THA or periprosthetic fracture (n=24)
Lost to follow-up or <2 years follow-up (n=392)

Follow-up

2–28.6 years (mean 10.3)

Statistics

Kaplan-Meier survivorshipCox proportional-hazards regressionLog-rank testChi-square test

Key Findings

Native hip survivorship after ORIF reaches 79% at 20 years (95% CI 76%–81%), but the true range is wide — best-case handling of lost follow-up pushes this to 86%, worst-case drops it to 52%
Failures cluster early: half of all 124 conversions happened within 1.5 years of fixation, after which the curve flattens into slow linear attrition — a hip that clears 18 months has passed the most dangerous phase of posttraumatic arthritis progression
Nine independent predictors of failure by multivariate Cox regression divide by what surgery can and cannot change:
–Noncontrollable at injury: age >40, anterior dislocation, posterior wall involvement, femoral head cartilage lesion, marginal impaction, displacement ≥20 mm
–Surgically controllable: nonanatomical reduction, incongruent acetabular roof, extended iliofemoral approach
Fracture pattern drives long-term outlook in a counterintuitive direction — both-column fractures had the best 20-year survivorship (87%, p=0.002) due to secondary surgical congruence, while anterior wall fractures had the worst (34%, p=0.002), though the anterior wall group was small (n=12)
Age is the steepest gradient in the series — patients under 40 reached 87% survivorship at 20 years versus only 51% in those over 65, a difference that should directly inform the primary THA versus joint preservation decision when multiple additional risk factors are present

Clinical Relevance

When counseling patients with acetabular fractures, you can cite that roughly 8 out of 10 hips will survive 20 years after ORIF. The nine identified risk factors should guide your surgical approach and help set appropriate expectations, particularly noting that displacement ≥20mm and age >40 significantly worsen prognosis.

Supplemental

Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

Tannast, Matta, et al.·J Bone Joint Surg Am·2012·429 citations·Trauma

Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

Study Snapshot

Key Findings

Clinical Relevance

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Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

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Key Findings

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Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

Study Snapshot

Key Findings

Clinical Relevance

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Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures.

Study Snapshot

Key Findings

Clinical Relevance

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