ORIF linked to higher reoperation risk than acute THA/CHP in older patients with acetabular fracturesHip replacement may lower reoperation risk for older fracture patients compared to repair

The Journal of arthroplasty Published June 1, 2026 Study authors: Brady Tyler T, Bera Shaylan R, Grammatopoulos George, Adamczyk Andrew P PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider acute THA/CHP over ORIF in older patients with acetabular fractures to reduce reoperation risk, but watch for dislocation.

This systematic review and meta-analysis compared outcomes of open reduction internal fixation (ORIF) versus acute total hip arthroplasty or hemiarthroplasty (THA/CHP) in 949 patients aged 60 years and older with acetabular fractures. The primary outcome was not reported; secondary outcomes included reoperation, post traumatic osteoarthritis, dislocation, and Harris Hip Scores.

Reoperation was significantly more common after ORIF (RR 2.60; 95% CI 1.42 to 4.75; P = 0.002). Post traumatic osteoarthritis occurred in 34% of ORIF patients. Dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores were higher in the arthroplasty group (mean difference -6.11; 95% CI -9.90 to -2.31; P = 0.002). Notably, ORIF patients were younger (mean difference -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02), suggesting potential selection bias.

The authors did not report specific limitations, but the observational nature of included studies and baseline differences between groups limit causal inference. For older patients with acetabular fractures, acute arthroplasty may reduce reoperation risk and improve functional outcomes, though dislocation risk is higher. Individualized surgical decision-making remains essential.

Hip fractures are terrifying for anyone over 60. They can happen suddenly and change lives in an instant. A new analysis looked at how to fix these breaks in older adults. The team compared two main paths: repairing the broken bone with metal plates or replacing the hip joint entirely.

They looked at 949 patients who had surgery. The data showed that repairing the bone led to more repeat operations. Specifically, the risk was 2.6 times higher for repair compared to replacement. This difference was clear and statistically significant.

The two groups also faced different challenges. People who got a hip replacement faced a higher chance of developing arthritis later. They also had a higher risk of the hip popping out of place. However, those who got the replacement had better pain scores and function on average.

The patients who needed repairs were generally younger and had lower anesthesia risk scores. The study looked at outcomes for up to 60 years after surgery. While the data is strong, doctors must weigh the risk of future arthritis against the risk of needing another surgery.

What this means for you:

Hip replacement surgery reduced repeat operations compared to repair for older fracture patients.

Study Details

Study typeMeta analysis

Sample sizen = 949

EvidenceLevel 1

Follow-up720.0 mo

PublishedJun 2026

PMID41106706

View Original Abstract ↓

BACKGROUND: Acetabular fractures in the elderly are increasingly common and associated with high morbidity and mortality. Although open reduction and internal fixation (ORIF) has been the mainstay of treatment, elderly outcomes have been less consistent. Acute total hip arthroplasty (THA), with or without fixation (combined hip procedure, CHP), is an alternative approach that may facilitate earlier mobilization and reduce early reoperation. This systematic review and meta-analysis compared outcomes of ORIF versus acute THA/CHP for acetabular fractures in patients aged 60 years and older. METHODS: A systematic review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched from 2000 to the present. Comparative studies reporting outcomes for ORIF and THA/CHP in patients aged ≥ 60 years were included. Reviewers independently screened and extracted data on demographics, interventions, complications, functional outcomes, and patient-reported outcome measures. Pooled incidence rates, risk ratios (RRs), and mean differences (MDs) were calculated using random-effects models. There were 13 studies and 949 patients (ORIF: 620; THA/CHP: 329) included. The pooled mean age was 74 years (range, 60 to 93). The ORIF patients were younger (MD: -4.14 years; P < 0.01) and had lower American Society of Anesthesiologists scores (P = 0.02). RESULTS: Reoperation was more common after ORIF (RR: 2.60; 95% confidence interval [CI]: 1.42 to 4.75; P = 0.002), with 84% of conversions due to posttraumatic osteoarthritis. The median time to conversion THA was 14.7 months. The post traumatic osteoarthritis incidence was 34% following ORIF; dislocation occurred in 8% of THA/CHP patients. Harris Hip Scores at one to 2 years postoperatively were higher in the arthroplasty group (MD -6.11; 95% CI: -9.90 to -2.31; P = 0.002). CONCLUSIONS: Acute THA/CHP may offer a viable treatment option in the elderly, demonstrating lower reoperation rates and improved function compared to ORIF.

ORIF linked to higher reoperation risk than acute THA/CHP in older patients with acetabular fracturesHip replacement may lower reoperation risk for older fracture patients compared to repair

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

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ORIF linked to higher reoperation risk than acute THA/CHP in older patients with acetabular fracturesHip replacement may lower reoperation risk for older fracture patients compared to repair

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

Clinical research that matters. Delivered to your inbox.

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