Analysis of predictive factors for post-traumatic osteoarthritis and poor outcomes in acetabular fractures treated surgically

OBJECTIVE: The aims of this study were (i) to assess the radiological and functional outcomes of surgically treated displaced acetabular fractures and (ii) to analyze the predictive factors of poor outcomes following surgery. METHODS: A total of 119 patients (24 female, 95 male) who were operated between 2009 and 2019 were included in the study. The mean age was 47.5 years (range = 18-61). The mean follow-up was 92.3 months (range = 24-120). Failure to preserve the biological hip joint, as treated with total hip replacement or the Girdlestone procedure, was defined as a poor outcome. Patients’ demographic information, comorbidities, fracture types, surgical approach, concomitant injuries, reduction quality, and complications were analyzed. Computed tomography was utilized to evaluate the fracture type and quality of reduction. Factors affecting poor outcomes were analyzed by logistic regression analysis. The modified Harris Hip Score was also used to evaluate the functional status. RESULTS: The poor outcome rate was 10.1%. Multivariate logistic regression analysis revealed that dislocation (odds ratio: 44.87, confidence interval: 3.18-633.22, P = .005), wound site problems (odds ratio: 9.09, confidence interval: 1.01-81.12, P = .04), reduction quality (odds ratio: 77.88, confidence interval: 5.95-1019.07, P = .001), and diabetes (odds ratio: 7.29, confidence interval: 1.01-52.07, P = .04) were associated with poor outcomes. Eight of the 12 patients with poor outcomes had a fair Harris Hip Score, and 4 had a poor Harris Hip Score. The relationship between poor outcomes and Harris Hip Score was found to be significant (P < .001). CONCLUSION: For a favorable functional outcome in acetabular fractures, preservation of the biological hip joint should be a top priority. The accompanying dislocation and the patient’s diabetes appear to be uncontrollable factors for the poor prognosis. Good reduction quality and wound infection protection are modifiable factors. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.