Fri., 10/9/09 Hip & Geriatric, Paper #42, 10:48 am OTA-2009
Does ORIF of Geriatric Acetabular Fractures Lead to Hip Arthroplasty and Poor Midterm Outcomes?
Robert V. O’Toole, MD (5-Synthes; 7-Synthes, Stryker, Smith &Nephew, DePuy);
Emily Hui, MPH (7-Synthes, Stryker, Smith &Nephew, DePuy); Amit Chandra, BA (n);
RA Cowley Shock Trauma Center, Dept. of Ortho, University of Maryland School of Medicine,
Baltimore, Maryland, USA
Purpose: Controversy continues to exist regarding the best treatment of geriatric patients with acetabular fractures. We hypothesized that a protocol of open reduction and internal fixation (ORIF) of displaced acetabular fractures would result in a high rate of conversion to hip arthroplasty and poor hi- specific validated outcome scores at midterm follow-up.
Methods: We performed a retrospective review of 147 consecutive patients ≥ 65 years of age with acetabular fractures treated at a single Level 1 trauma center during 2001 to 2006. During this time, fractures that met operative criteria were typically treated with operative fixation unless the patient’s medical condition warranted nonoperative treatment. We excluded 29 patients (19.8%) who we were lost to follow-up. Of the remaining 118 patients, 46 (39%) were deceased, with death occurring at an average of 1.7 years after treatment, and a 1-year mortality of 25.0%. Of the surviving 71 patients, 11 (15%) refused to participate in the study, leaving 61 patients in our study group. Our average follow-up was 4.3 years (range, 1.1-7.9 years). We performed standardized phone interviews that included hip-specific questions, including the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and a Short Form-8 (SF-8) as validated outcome measures.
Results: Of the 61 living patients in the study group, 52 (85%) were treated operatively (46 with ORIF and 6 with percutaneous fixation only) and the remaining 9 nonoperatively. The ORIF group went on to hip arthroplasty in 18% of patients (28% of the living patients) at an average of 2.5 years after injury (range, 0.4-5.5 years). The ORIF patients had an average WOMAC score of 17.3 (range, 0-56; function component = 11.6; pain component = 3.3; n = 36), which is similar or better than results typical after elective arthroplasty for arthritis and much better than patients with established arthritis (P <0.05). Despite these favorable results, 39% of the patients reported some difficulty walking long distances and 45% reported some level of hip pain. The average SF-8 physical component score was 46.1 (range, 31-62), which is similar to United States population norms for this age group (P >0.20).
Conclusions: Little data exist describing the longer-term outcomes after treatment of geriatric patients with acetabular fractures to help clinicians to decide between ORIF, acute arthroplasty, and nonoperative treatment. We have presented outcomes of our treatment protocol at an average of 4.3 years using mostly ORIF that demonstrated a high 1-year mortality of 25% but conversion to arthroplasty at a rate of only 18%. Health outcome measures in the surviving patients were similar to population norms and the validated hip-specific outcomes were comparable to results after elective arthroplasty.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant