Risk factors for acetabular fracture treatment failure: a systematic review and meta-analysis

Introduction: Acetabular fractures can lead to persistent pain and disability. Managing these complex injuries involves several treatment options such as nonoperative methods, percutaneous fixation, open reduction internal fixation (ORIF), and total hip arthroplasty (THA), and various combinations of these techniques. Around 20 to 40% of patients treated with ORIF may develop post-traumatic arthritis requiring THA. To pinpoint the factors contributing to initial treatment failure of acetabular fractures and the subsequent need for THA conversion, we are conducting a systematic review of relevant literature.

Methods: A thorough search of PubMed, Scopus, Web of Science, and Embase databases yielded studies investigating risk factors linked to the conversion of acetabular fracture treatment to THA. Inclusion criteria were employed, and data extraction, as well as quality assessment, were conducted by two reviewers. Utilizing R software, meta-analyses were conducted employing the Mantel-Haenszel method. Random-effect models were employed when the I² was greater than 50% (Heterogeneous data). A P-value less than 0.05 is considered statistically significant.

Results: In this systematic review involving 25 pertinent studies, our analysis unveiled significant risk factors contributing to the conversion from initial acetabular fracture treatment to THA. Notable factors included advanced age (SMD [95%CI] = 0.43 [0.17-0.69]), female gender (OR [95%CI] = 1.65 [1.15-2.38]), posterior wall involvement (OR [95%CI] = 1.81 [1.32-2.47]), acetabular impaction (OR [95%CI] = 3.23 [1.99-5.25]), femoral impaction (OR [95%CI] = 6.08 [3.35-11.05]), and femoral head dislocation (OR [95%CI] = 3.94 [2.02-7.70]). Associated fracture type exhibited no significant link to the risk of conversion to THA.

Conclusion: Recognizing these factors allows for the adjustment of patient expectations, providing them with information about the potential necessity of THA in the future. Patients exhibiting these risk factors may derive greater benefits from treatment administered by experienced surgeons.