Primary Arthroplasty Beats ORIF for Function in Geriatric Acetabular FracturesPrimary Hip Replacement Shows Better Outcomes for Acetabular Fractures
InjuryPublished October 7, 2026Study authors: Halvachizadeh Sascha, Starr Adam J, Bell Louisa, Pfeifer Roman, Osterhoff Georg, Höch Andreas, Hilde…PubMed ↗DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
Primary arthroplasty improved early function and reduced reoperation versus ORIF in geriatric acetabular fractures.
A meta-analysis of 2,703 geriatric patients (aged 55 years and older) with acetabular fractures compared primary total hip arthroplasty or combined hip procedure (CHP) against open reduction and internal fixation (ORIF).
Functional outcomes favored arthroplasty. Harris Hip Scores at three months were 73.6 with THA/CHP versus 66.3 with ORIF (p < 0.05).
Reoperation rates were substantially lower after THA/CHP, ranging from 4.4% to 7.7%, compared with 14% to 45% after ORIF (OR 2.34; 95% CI 1.31-5.67; p < 0.001).
Mortality at 90 days did not differ significantly between groups: 15% with THA/CHP versus 11% with ORIF (OR 1.08; 95% CI 0.58-2.02; p = 0.82).
Trade-offs included longer median operative time (185 vs 125 minutes; p < 0.001) and greater median intraoperative blood loss (1000 ml vs 500 ml; p = 0.006).
These findings support primary trauma arthroplasty, sometimes termed fix and replace, for geriatric patients with comminuted acetabular fractures or joint impaction. The analysis is observational, so results reflect association rather than proven causation. Safety data, funding, and conflicts of interest were not reported.
How this fits prior evidence
Prior coverage reported that ORIF was linked to higher reoperation risk than acute THA/CHP in older patients with acetabular fractures. This meta-analysis confirms that finding, reporting an OR of 2.34 (95% CI 1.31-5.67, p < 0.001) for reoperation with ORIF compared with THA/CHP. It extends prior coverage by adding functional outcome data, showing a Harris Hip Score of 73.6 with THA/CHP versus 66.3 with ORIF at three months (p < 0.05), and by reporting no significant difference in 90-day mortality (OR 1.08, 95% CI 0.58-2.02, p = 0.82).
This meta-analysis looked at 2,703 older patients, aged 55 and over, who suffered from acetabular fractures. Researchers compared two surgical methods: a combined hip procedure (CHP) and a standard surgery known as ORIF. The study focused on how well patients moved and their overall health after the operation.
Patients who received the combined hip procedure reported higher functional scores at the three-month mark compared to those who had the standard surgery. While the combined procedure took longer to perform and involved more blood loss during surgery, it was linked to significantly lower reoperation rates. The study also found no significant difference in mortality rates at 90 days between the two groups.
These findings suggest that the combined approach may be a more effective option for older patients with complex hip fractures. However, because this is a meta-analysis, the results show a link between the procedure and better outcomes rather than a guaranteed result for every patient. You should talk to your surgeon to decide which method is best for your specific injury.
What this means for you:
Combined hip procedures may offer better function and fewer reoperations for older patients with certain hip fractures.
Common questions
Who is this finding most relevant for?
This finding specifically concerns geriatric patients aged 55 and older who have suffered from acetabular fractures. The study suggests that a combined hip procedure may offer better functional outcomes for these patients compared to standard surgery.
What are the differences in recovery and surgery time?
The combined procedure resulted in higher functional scores at three months compared to standard surgery. However, the combined procedure took longer to perform (185 minutes versus 125 minutes) and involved more blood loss (1000 ml versus 500 ml) during the operation.
Is the combined procedure safer regarding reoperation?
The study found that the combined procedure was linked to lower reoperation rates, ranging from 4.4% to 7.7%, compared to 14% to 45% for the standard surgery. There was no significant difference in the 90-day mortality rate between the two groups.
INTRODUCTION: Acetabular fractures in geriatric patients are increasing in frequency and present unique challenges due to poor bone quality and pre-existing osteoarthritis. High rates of secondary conversion to Total Hip Arthroplasty (THA) have led to the increased use of a "Fix and Replace" strategy (Trauma Arthroplasty). This systematic review and meta-analysis compares clinical outcomes and complications of ORIF with primary THA/Combined Hip Procedure (CHP) based on fracture-based treatment strategies in the elderly.
METHODS: A systematic literature search was conducted (PubMed, Embase, Cochrane, and Web of Science) for studies published between 1997 and 2025 involving patients aged ≥55 years with acetabular fractures. We compared ORIF (n = 2034) versus Arthroplasty (CHP/THA, n = 417) [Synthesized from updated dataset]. Primary outcomes were functional scores (Harris Hip Score and Oxford Hip Score), 90-day and 1-year mortality rates, and reoperation/conversion rates. Absolute numbers and pooled odds ratios (OR) were calculated using a random-effects model RESULTS: Out of 2163 screened articles, 20 (0.9%) were included in this study, encompassing a total cohort of 2703 patients. The mean age of the study population was 74.14 years (SD 6.97), with a mean ASA score of 2.8. The primary THA/CHP group achieved a significantly higher postoperative Harris Hip Score with a mean of 73.6 compared to 66.3 in the ORIF group at three months (p < 0.05). Surgical intensity was higher in the "Fix and Replace" cohort in several series, which demonstrated a significantly longer median operative time (185 vs. 125 min, p < 0.001) and an increased intraoperative blood loss (median 1000 ml vs. 500 ml, p = 0.006) compared to isolated ORIF. The 90-day mortality rate was 11% for ORIF and 15% for THA/CHP, showing no statistically significant difference (OR 1.08; 95% CI 0.58-2.02; p = 0.82). Patients initially treated with ORIF had a significantly higher risk of failure requiring secondary surgery, with a 14-45% conversion rate to THA due to post-traumatic osteoarthritis or hardware failure. The primary THA/CHP group had a significantly lower reoperation rate of 4.4% to 7.7%, yielding a pooled odds ratio of 2.34 (95% CI 1.31-5.67; p < 0.001) in favor of primary arthroplasty CONCLUSION: Primary Trauma Arthroplasty (Fix and Replace) provides superior functional outcomes and lower reoperation rates compared to ORIF alone in geriatric patients with comminuted acetabular fractures or joint impaction. While surgical intensity is higher, the avoidance of "failed" osteosynthesis and subsequent complex revision surgery suggests that primary THA is a viable first-line treatment for selected elderly patients.
