Functional and radiological outcomes in elderly acetabular fracture patients treated with internal fixation and acute total hip arthroplasty

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Koskinen, Anders Enocson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7244718/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Acetabular fractures in elderly are associated with complex fracture patterns and poor bone quality. Internal fixation alone in these patients has been associated with poor outcome. Internal fixation combined with acute total hip arthroplasty (THA) is an approach to stabilize the acetabulum and restore hip function, however functional and radiological data are still limited. Methods Patients ≥ 60 years with an acetabular fracture treated with acute THA and additional acetabular fixation were followed up at least one year postoperatively. All patients were treated from 2017 to 2023 at the Karolinska University Hospital within 21 days after trauma. Medical records were reviewed, functional examinations and radiographic assessment were performed. Results A total of 32 patients were included. The median (IQR, range) age was 77 (35, 60–95) years and 22% (n = 7) were females. Dome impaction (94%, n = 30) was the main indication for THA and the median follow-up time was 3.1 years. Two (6%) patients had a postoperative hip dislocation. Three (9%) patients had a deep infection and 22% (n = 7) sustained at least one non-surgical complication. The median Harris Hip Score was 87 (33, 33.3–100) and the median EQ-5D-3L index score was 0.7 (0.5, 0.0–1.0). Heterotopic ossification was observed in 94% (n = 30) of the patients, mostly Brooker grade 1 (n = 18, 56%). No radiological signs of loosening of the acetabular reinforcement ring or the cup was observed. Conclusions Internal fixation with acute THA among elderly may yield a good functional outcome with no signs of acetabular implant loosening in this mid-term follow-up. Acetabular fracture Elderly Acute total hip arthroplasty fix and replace Harris Hip score EQ-5D Figures Figure 1 Figure 2 Figure 3 Introduction Displaced acetabular fractures in elderly cause severe morbidity and increased risk of mortality ( 1 ). In addition, these injuries have been difficult to treat with open reduction and internal fixation (ORIF) due to osteopenic bone structure, which in turn may lead to implant failure and subsequent need for secondary conversion to total hip arthroplasty (THA) ( 2 , 3 ). Predictors for poor prognosis after ORIF include substantial impaction or comminution of the weight bearing surface/dome and posterior wall fracture patterns ( 4 ). Furthermore, delayed THA has been associated with more technical difficulties as patients tend to develop significant scarring in combination with altered anatomy ( 5 ). To circumvent the issue of insufficient fixation of the acetabular fracture and late posttraumatic complications, the method of combining internal fixation with an acute primary THA has been under development ( 5 ), sometimes with the use of a reinforcement ring ( 6 , 7 ). The major benefit is early mobilization with full weight bearing with the potential to rehabilitate frail elderly more promptly after surgery, thereby avoiding complications associated with inactivity ( 8 ). As acetabular fracture surgery with THA may be complex and the risk of complications high ( 9 ), functional evaluation of this patient group is needed. Therefore, the aim of this study was to elucidate radiographic and functional outcomes after fracture fixation and acute THA in elderly patients with an acetabular fracture. Methods Patients All elderly patients with a displaced acetabular fracture treated with a combination of acetabular fracture fixation and a THA between 2017 and 2023 at the Karolinska University hospital were identified in the clinical database. All the patients were operated by different senior, consultant orthopedic surgeons with many years of experience in acetabular/pelvic fracture surgery as well as hip arthroplasty. Inclusion criteria for the study were age from 60 years at the time of surgery, surgery within 21 days after the injury and a combination of primary THA and additional acetabular fracture fixation (plate fixation and/or reinforcement ring). Exclusion criteria were pathological acetabular fracture, acetabular periprosthetic fracture, inability to attend a follow-up due to geographic inconvenience, pronounced cognitive impairment, drug abuse or any severe medical impairments that hindered attendance. All eligible patients were offered a follow-up, at a minimum of one year postoperatively. The follow-up consisted of clinical examination as well as assessment of functional and radiological outcomes. In addition, patient records including previous radiographs were analyzed. Collected parameters consisted of patient-related characteristics, injury-related data, reoperations and complications. An infection was defined as a combination of clinical findings and positive cultures from the operation site. All fractures were analyzed from the preoperative computed tomography (CT) scan and classified according to Judet-Letournel (10) by two of the authors (DC and AE). Functional assessments The patients´ hip function was assessed using the Harris Hip Score and their health-related quality of life by the EQ-5D-3L. Harris Hip Score is a functional scoring system, which includes a patient-derived report of dysfunction in daily life as well as clinical examination of range of motion. It generates a score up to 100 points where 90-100 points corresponds to excellent function, 80-89 good, 70-79 fair, and <70 poor (11). EQ-5D-3L assesses five different areas/dimensions pertaining to health-related quality of life such as mobility, self-care, usual activity, pain or discomfort, anxiety or depression. These dimensions can be used to generate the EQ-5D-3L index score, a numerical value from 0 (worst possible health) to 1 (best possible health) (12). Radiological assessments An anteroposterior (AP) pelvic, AP and groin-lateral radiographs of the operated hip obtained were analyzed. The variables analyzed were the degree of heterotopic ossification (HO) formation around the hip (13) and presence of radiolucent zones between the bone and cement in both acetabular and femoral components of the prosthesis. The cup/reinforcement ring was divided into three zones and the femoral stem into seven zones as described earlier (14,15). The radiographs were evaluated chronologically to assess progressive changes in the width or length of radiolucent zones and a dichotomous scale was used, i.e. radiolucent zone is not present vs. radiolucent zone is present on radiographs obtained the time of the last clinical follow-up. A senior radiologist with more than 25 years of experience in musculoskeletal radiology (SK) analyzed the radiographs using PACS workstation (Sectra PACS IDS7, v.23.1, Linköping, Sweden). The imaging and clinical data were neither blinded nor anonymized. Statistical analysis The numerical data were presented as median (IQR, range) and the categorical data as frequencies and/or percentages. The analyses were conducted using IBM SPSS Statistics, version 29.0 (IBM Corp., Armonk, NY, USA). Ethical approval This study was approved by the Swedish Ethical Review Authority, Reference Number 2023-05170-01. Results Patient characteristics Initially, 83 elderly patients operated with the combined method were identified. After exclusion of 41 patients not fulfilling the inclusion criteria, 42 patients were eligible and offered a follow-up. Another 10 patients were excluded due to medical frailty, cognitive dysfunction, or declined to participate. The final number of patients that attended the follow-up was 32 (Fig. 1). The median age at the time of surgery for all patients was 77 (35, 60-95) years and the cohort consisted of 22% (n=7) females. The ASA-class was ASA II (47%, n=15) or ASA III (53%, n=17). The majority of the injuries were the result of a low-energy trauma (78%, n=25) due to a simple fall (75%, n=24). Some patients sustained associated injuries, including chest injury (6%, n=2), major upper limb injury (6%, n=2), head injury (3%, n=1) and/or major lower limb injury (3%, n=1). The most common acetabular fracture patterns were anterior column + posterior hemitransverse (44%, n=14), followed by associated both column (25%, n=8) and anterior column (22%, n=7) (Fig. 2a). The majority of the patients had dome impaction (94%, n=30) as the surgical indication for THA rather than fracture fixation only. A total of 47% (n=15) of the patients were operated within 72 hours from hospital admission and the median length of stay at the hospital was 6 days (5, 2-30). The median follow-up time was 1122 (894, 376-2528) days (3.1 years). Additional patient and injury characteristics are presented in Table 1. Table 1 Patient characteristics, injury- and treatment-related variables Variable Value Age (years), median (IQR, range) 77 (35, 60-95) Female gender, n (%) 7 (22) ASA-class ASA II, n (%) 15 (47) ASA III, n (%) 17 (53) Mechanism of injury Simple fall, n (%) 24 (75) Fall from height, n (%) 4 (13) Bicycle accident, n (%) 4 (13) Associated injuries Head injury, n (%) 1 (3) Chest injury, n (%) 2 (6) Major upper limb injury, n (%) 2 (6) Major lower limb injury, n (%) 1 (3) Judet-Letournel fracture type Anterior column, n (%) 7 (22) Posterior wall, n (%) 2 (6) Anterior column + posterior hemitransverse, n (%) 14 (44) Both columns, n (%) 8 (25) Unable to classify, n (%) 1 (3) Indication for THA Dome impaction, n (%) 30 (94) Posterior wall injury, n (%) 2 (6) Operated within 72 hours, n (%) 15 (47) Hospital length of stay (days), median (IQR, range) 6 (5, 2-30) Treatment All patients were operated with a cemented primary THA with a Lubinus SPII stem (Waldemar Link, Hamburg, Germany) and a Lubinus SPII cup (n=3) or Marathon cup (n=29) (DePuy Synthes, Richmond, Virginia, USA). The most common acetabular fracture fixation was a combination of an anterior plate with a reinforcement ring (50%, n=16) and the mostly used ring was a Müller ring (91%, n=29) (Zimmer Biomet, Warsaw, Indiana, US) (Fig. 2b). The hip prosthesis approaches used was an anterolateral (81%, n=26) or a posterior approach (19%, n=6), all in lateral decubitus position. The median perioperative blood loss was 700 ml (825, 300-1900). Complications Reoperations occurred in two (6%) patients due to hip dislocation, where of one was operated by a posterior approach with a Burch-Schneider ring (Zimmer Biomet, Warsaw, Indiana, US) and the other by an anterolateral approach with a Müller ring. Both patients went through two closed reductions and subsequently underwent cup revision as the final treatment. Deep infection was detected in three patients (9%) with two of them occurring at least one year postoperatively, while the last one within the first week. Subsequently, all of them were treated with long term antibiotics only as one patient rejected surgery and two were judged to be too frail for further extensive revision surgery. Moreover, 22% (n=7) of the patients sustained at least one non-surgical complication which included four (13%) cases of pulmonary embolism, one (3%) case of pneumonia, one (3%) case of urinary tract infection and one (3%) patient with deep venous thrombosis (Table 2). Table 2 Type of fixation and in relation to fracture type Fixation type (n) Fracture type (n ) Ring Ring + anterior plate Ring + posterior plate Ring + double plate Posterior plate Total Anterior column 3 4 0 0 0 7 Posterior wall 0 0 1 0 1 2 Anterior column + posterior hemitransverse 5 9 0 0 0 14 Associated both column 1 2 4 1 0 8 Unable to classify 0 1 0 0 0 1 Total 9 16 5 1 1 Radiological outcomes Signs of stem loosening according to Gruen zones were observed in eight (25%) patients, with zone 1 as the most common area (n=6, 19%). Three (9%) patients showed multiple zones of radiolucency. In contrast, none of the patients showed signs of acetabular cup or reinforcement ring loosening in DeLee & Charnley zones. Heterotopic ossification was observed in 94% (n=30) of the patients with most of them being Brooker grade 1 (n=18, 56%), and only one patient (3%) with grade 4 (Table 3). Table 3 Radiological findings of stem loosening (Gruen zones), cup/ring loosening (DeLee & Charnley zones), and heterotopic ossification (Brooker classification) at follow-up Variable Patients n (%) Stem loosening Zone 1 6 (19) Zone 2 1 (3) Zone 3 1 (3) Zone 4 0 Zone 5 0 Zone 6 1 (3) Zone 7 4 (13) Multiple zones 3 (9) Cup/ring loosening Zone 1 0 Zone 2 0 Zone 3 0 Heterotopic ossification Grade 1 18 (56) Grade 2 5 (16) Grade 3 6 (19) Grade 4 1 (3) Functional outcomes The median Harris hip Score for all patients was 87 (33, 33-100), which corresponds to good function. Fourteen patients (44%) were considered as excellent, 6 (19%) as good, 3 (9%) as fair, and 9 (28%) as poor. The median EQ-5D-3L index score for all patients was 0.7 (0.5, 0.0-1.0) where 63% (n=20) of the patients reported some difficulties to walk, 56% (n=18) some pain/discomfort, and 50% (n=16) some anxiety/depression. Among the patients that reported extreme difficulties, self-hygiene (n=4, 13%) and pain (n=4, 13%) were the most commonly affected domains (Table 4). A positive correlation between HHS and EQ-5D-3L index score was found (ρ=0.8, p=0.001, n=32), suggesting that higher HHS was associated with higher EQ-5D-3L index score (Fig. 3). Table 4 Overview of functional outcomes at follow-up Variable Value Harris Hip score, median (IQR, range) 87 (33, 33-100) Excellent (≥90), n (%) 14 (44) Good (80-89), n (%) 6 (19) Fair (70-79), n (%) 3 (9) Poor (<70), n (%) 9 (28) EQ-5D-3L index score, median (IQR, range) 0.7 (0.5, 0.0-1.0). Mobility No difficulty, n (%) 10 (31) Some difficulties, n (%) 20 (63) Extreme difficulties, n (%) 2 (6) Self-care No difficulty, n (%) 21 (66) Some difficulties, n (%) 7 (22) Extreme difficulties, n (%) 4 (13) Usual activities No difficulty, n (%) 19 (59) Some difficulties, n (%) 10 (31) Extreme difficulties, n (%) 3 (9) Pain/discomfort No difficulty, n (%) 10 (31) Some difficulties, n (%) 18 (56) Extreme difficulties, n (%) 4 (13) Anxiety/depression No difficulty, n (%) 16 (50) Some difficulties, n (%) 16 (50) Extreme difficulties, n (%) 0 (0) Discussion In this study, the functional and radiological outcomes of elderly acetabular fracture patients operated with internal fixation and acute THA, were investigated. The main findings were a good function and the absence of acetabular component loosening. The fracture patterns and methods of combining fixation with THA among the patients were slightly heterogeneous. Most of the patients (n=31, 97%) were operated with a reinforcement ring in combination with or without additional plating. Despite this, none of the patients showed loosening of either the ring or the cup, even among patients followed up to 6.9 years postoperatively, which may suggest long-term durability of the acetabular component, as indicated by a previous report (7). Although radiolucency around the femoral stem was observed in 25% of the patients, most of them did not show engagement of multiple zones and therefore do not necessarily correlate with clinically significant loosening (16). HO was observed in 30 (94%) patients with 6 (19%) having grade 3 and 1 (3%) grade 4. No correlation between HO and HHS or EQ-5D-3L index score could be observed, which might be due to insufficient patient numbers or the fact that most patients only had a grade 1 HO. The functional outcomes of this study align with previously reported results in the literature (17–19). In a 2022 systematic review, McCormick et al. compared the outcomes of different treatments for acetabular fractures in the elderly by pooling thirty-eight studies (19). An average HHS of 85 (74-93) was reported among the ORIF+THA group, which was comparable to the results of this study. Furthermore, when compared to hip fracture patients operated with THA and similar follow-up time, the mean HHS was similar with a score of 87 (± 9.4) at 1 year postoperatively and 89 (± 8.1) at 4 years among the hip fracture patients in a 2011 RCT by Hedbeck et al. (20). In addition, the EQ-5D-3L score for both this study and the study by Hedbeck et al. was similar as they showed a score of 0.68 at 1 year and 4 years postoperatively. The correlation between the HHS and EQ-5D-3L in this study indicates a concordance between the values from the patients’ self-reporting and those derived from the clinical examination. As many of the patients reported at least some pain/discomfort and anxiety/depression, it illustrates the importance of additional long term postoperative rehabilitation and care. In this study, 22% of the patients had a non-surgical complication and 16% had a surgically related complication with 2 cases of hip dislocation. For comparison, McCormick et al. reported a complication rate of 25% for ORIF+THA patients, which was lower than for ORIF alone (38%) and with an OR of 1.87 (19). The rate of dislocations was comparable to a previous report on ORIF+THA patients where Basset et al. reported a 6% dislocation in a cohort of 51 patients (21). In contrast, Liang et al. reported up to 12% dislocations in a 2023 meta-analysis with a total of 255 patients (22). The major strengths of this study were the relatively long follow-up time with an average of approximately 3 years and the use of standardized assessments (e.g. HHS, EQ-5D-3L, radiographic classifications). There are some limiting factors, such as the single site design, patient-cohort size and the exclusion criteria. This in turn may skew the data towards examining only the patients that are motivated and healthy enough to attend the follow-up. As the complication rate was considerable, it is important to assess whether there are potential clinical factors for predicting adverse outcomes in patients that undergo ORIF+THA surgery. Furthermore, despite the absence of cup or reinforcement ring loosening, future studies to examine implant stability in a clinical setting is needed to evaluate if there is implant/fracture movement that could give rise to late subsequent implant loosening. In conclusion, this study suggests that internal fixation with acute THA among elderly may yield a good functional outcome with no signs of acetabular implant loosening. Abbreviations HO; Heterotopic ossification. HHS; Harris Hip Score. ORIF; Open reduction and internal fixation. THA; Total hip arthroplasty. Declarations Ethics approval and consent to participate This study was approved by the Swedish Ethical Review Authority, which is the national authority responsible for all ethical review in Sweden. The approval number is 2023-05170-01. All study participants have given written informed consent prior to participating in the study. Clinical trial number: Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used during and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Funding This study was funded by Promobilia (grant number A23117). Authors´contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DC and AE. Radiological data interpretation was performed by SK. The first draft of the manuscript was written by DC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements Luigi Belcastro, for valuable contribution with patient coordination. References Gary JL, Paryavi E, Gibbons SD, Weaver MJ, Morgan JH, Ryan SP, et al. Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma. 2015 Apr;29(4):202–8. O’Toole RV, Hui E, Chandra A, Nascone JW. How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty? J Orthop Trauma. 2014 Mar;28(3):148–53. Navarre P, Gabbe BJ, Griffin XL, Russ MK, Bucknill AT, Edwards E, et al. Outcomes following operatively managed acetabular fractures in patients aged 60 years and older. Bone Joint J. 2020 Dec;102-B(12):1735–42. Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010 Feb;92(2):250–7. Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002 Jan;84(1):1–9. Tidermark J, Blomfeldt R, Ponzer S, Söderqvist A, Törnkvist H. Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients. J Orthop Trauma. 2003 Mar;17(3):193–7. Enocson A, Blomfeldt R. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma. 2014 Jun;28(6):330–7. Rickman M, Young J, Trompeter A, Pearce R, Hamilton M. Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing. Clin Orthop Relat Res. 2014 Nov;472(11):3375–82. Lundin N, Berg HE, Enocson A. Complications after surgical treatment of acetabular fractures: a 5-year follow-up of 229 patients. Eur J Orthop Surg Traumatol. 2023 May;33(4):1245–53. R J, J J, E L. FRACTURES OF THE ACETABULUM: CLASSIFICATION AND SURGICAL APPROACHES FOR OPEN REDUCTION. PRELIMINARY REPORT. The Journal of bone and joint surgery American volume [Internet]. 1964 Dec [cited 2025 May 8];46. Available from: https://pubmed.ncbi.nlm.nih.gov/14239854/ Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737–55. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997 Nov;35(11):1095–108. Brooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973 Dec;55(8):1629–32. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;(121):20–32. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979 Jun;(141):17–27. Katzer A, Lœhr JF. Early loosening of hip replacements: causes, course and diagnosis. J Orthopaed Traumatol. 2003 Dec;4(3):105–16. De Bellis UG, Legnani C, Calori GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury. 2014 Feb;45(2):356–61. Iqbal F, Ullah A, Younus S, Aliuddin A, Zia OB, Khan N. Functional outcome of acute primary total hip replacement after complex acetabular fractures. Eur J Orthop Surg Traumatol. 2018 Dec;28(8):1609–16. McCormick BP, Serino J, Orman S, Webb AR, Wang DX, Mohamadi A, et al. Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review. Eur J Orthop Surg Traumatol. 2022 May;32(4):649–59. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am. 2011 Mar 2;93(5):445–50. Bassett JW, Diamond OJ, Spence DJ, Ward AJ, Acharya MR, Chesser TJ. Mid-term results of the treatment of complex acetabular fractures with combined acute fixation and total hip replacement in the older patient. Hip Int. 2023 Nov;33(6):1093–9. Liang K, Gani MH, Griffin X, Culpan P, Mukabeta T, Bates P. Acute versus delayed total hip arthroplasty after acetabular fracture fixation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2683–93. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7244718","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500908082,"identity":"800e8bd8-bc96-467e-bcac-b033d127e9c4","order_by":0,"name":"David Chang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDCCA0DEw8CQAGQyPmwwIFELsyHRWhigWtgkG4jRwXf8jOGBNwx2efyz269VzihgsOcnpEXyTI7BwTkMycUSd86U3dxgwJA4k5BVBgfSEg7zMBxIbLiRk3bzgQFDgsEBQlrOP4NomQ/UUgjUYm9PUMuN5ANgLRtupB9jBDqMcQNBv9x4fODgHIPkxI03cpglZxhIJM4gZAvf+cTmD28q7BLn3Uh/+LHnj409fwMhayDOAxE8IFKCKPUwwP6AJOWjYBSMglEwcgAAFUxJzgFxopUAAAAASUVORK5CYII=","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Chang","suffix":""},{"id":500908083,"identity":"3956e257-a063-48f3-b689-03c52359ab37","order_by":1,"name":"Seppo K. Koskinen","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Seppo","middleName":"K.","lastName":"Koskinen","suffix":""},{"id":500908084,"identity":"11d600cc-fffb-40d6-9c18-ce53fff3b36e","order_by":2,"name":"Anders Enocson","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Anders","middleName":"","lastName":"Enocson","suffix":""}],"badges":[],"createdAt":"2025-07-29 15:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7244718/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7244718/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89544161,"identity":"74d9e6cf-630e-4602-821d-558885221320","added_by":"auto","created_at":"2025-08-21 06:57:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":184949,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the patient selection process\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7244718/v1/8f358ae855d8c13ce3392e43.png"},{"id":89544164,"identity":"5d30675f-aec0-412f-a1c7-c6185f492bc4","added_by":"auto","created_at":"2025-08-21 06:57:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":613942,"visible":true,"origin":"","legend":"\u003cp\u003ePatient with anterior column + posterior hemitransverse fracture, medial protrusion of the femoral head (a). Operated with ORIF, reinforcement ring and acute THA (b)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7244718/v1/6bd1787cfdfbbc3482a0c24f.png"},{"id":89544160,"identity":"cf14a9c1-280b-4960-8334-0ffc4b53775a","added_by":"auto","created_at":"2025-08-21 06:57:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":99688,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot of EQ-5D-3L index score as a function of HHS\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7244718/v1/01b213f49c1f5ff7f297d88e.png"},{"id":92835171,"identity":"ee1c533f-1cac-448b-b313-73408a3d9bce","added_by":"auto","created_at":"2025-10-06 07:32:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1715795,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7244718/v1/ef00b204-8ebf-43d5-88d8-c15a634867a4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Functional and radiological outcomes in elderly acetabular fracture patients treated with internal fixation and acute total hip arthroplasty","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDisplaced acetabular fractures in elderly cause severe morbidity and increased risk of mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In addition, these injuries have been difficult to treat with open reduction and internal fixation (ORIF) due to osteopenic bone structure, which in turn may lead to implant failure and subsequent need for secondary conversion to total hip arthroplasty (THA) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Predictors for poor prognosis after ORIF include substantial impaction or comminution of the weight bearing surface/dome and posterior wall fracture patterns (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Furthermore, delayed THA has been associated with more technical difficulties as patients tend to develop significant scarring in combination with altered anatomy (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). To circumvent the issue of insufficient fixation of the acetabular fracture and late posttraumatic complications, the method of combining internal fixation with an acute primary THA has been under development (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), sometimes with the use of a reinforcement ring (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The major benefit is early mobilization with full weight bearing with the potential to rehabilitate frail elderly more promptly after surgery, thereby avoiding complications associated with inactivity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). As acetabular fracture surgery with THA may be complex and the risk of complications high (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), functional evaluation of this patient group is needed. Therefore, the aim of this study was to elucidate radiographic and functional outcomes after fracture fixation and acute THA in elderly patients with an acetabular fracture.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll elderly patients with a displaced acetabular fracture treated with a combination of acetabular fracture fixation and a THA between 2017 and 2023 at the Karolinska University hospital were identified in the clinical database. All the patients were operated by different senior, consultant orthopedic surgeons with many years of experience in acetabular/pelvic fracture surgery as well as hip arthroplasty. Inclusion criteria for the study were age from 60 years at the time of surgery, surgery within 21 days after the injury and a combination of primary THA and additional acetabular fracture fixation (plate fixation and/or reinforcement ring). Exclusion criteria were pathological acetabular fracture, acetabular periprosthetic fracture, inability to attend a follow-up due to geographic inconvenience, pronounced cognitive impairment, drug abuse or any severe medical impairments that hindered attendance. \u0026nbsp;All eligible patients were offered a follow-up, at a minimum of one year postoperatively. The follow-up consisted of clinical examination as well as assessment of functional and radiological outcomes. In addition, patient records including previous radiographs were analyzed. Collected parameters consisted of patient-related characteristics, injury-related data, reoperations and complications. An infection was defined as a combination of clinical findings and positive cultures from the operation site. All fractures were analyzed from the preoperative computed tomography (CT) scan and classified according to Judet-Letournel (10) by two of the authors (DC and AE). \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional assessments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients\u0026acute; hip function was assessed using the Harris Hip Score and their health-related quality of life by the EQ-5D-3L. Harris Hip Score is a functional scoring system, which includes a patient-derived report of dysfunction in daily life as well as clinical examination of range of motion. It generates a score up to 100 points where 90-100 points corresponds to excellent function, 80-89 good, 70-79 fair, and \u0026lt;70 poor (11). \u0026nbsp;EQ-5D-3L assesses five different areas/dimensions pertaining to health-related quality of life such as mobility, self-care, usual activity, pain or discomfort, anxiety or depression. These dimensions can be used to generate the EQ-5D-3L index score, a numerical value from 0 (worst possible health) to 1 (best possible health) (12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological assessments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn anteroposterior (AP) pelvic, AP and groin-lateral radiographs of the operated hip obtained were analyzed. The variables analyzed were the degree of heterotopic ossification (HO) formation around the hip (13) and presence of radiolucent zones between the bone and cement in both acetabular and femoral components of the prosthesis. The cup/reinforcement ring was divided into three zones and the femoral stem into seven zones as described earlier (14,15). The radiographs were evaluated chronologically to assess progressive changes in the width or length of radiolucent zones and a dichotomous scale was used, i.e. radiolucent zone is not present vs. radiolucent zone is present on radiographs obtained the time of the last clinical follow-up.\u003c/p\u003e\n\u003cp\u003eA senior radiologist with more than 25 years of experience in musculoskeletal radiology (SK) analyzed the radiographs using PACS workstation (Sectra PACS IDS7, v.23.1, Link\u0026ouml;ping, Sweden). The imaging and clinical data were neither blinded nor anonymized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe numerical data were presented as median (IQR, range) and the categorical data as frequencies and/or percentages. The analyses were conducted using IBM SPSS Statistics, version 29.0 (IBM Corp., Armonk, NY, USA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Swedish Ethical Review Authority, Reference Number 2023-05170-01.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, 83 elderly patients operated with the combined method were identified. After exclusion of 41 patients not fulfilling the inclusion criteria, 42 patients were eligible and offered a follow-up. Another 10 patients were excluded due to medical frailty, cognitive dysfunction, or declined to participate. The final number of patients that attended the follow-up was 32 (Fig. 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median age at the time of surgery for all patients was 77 (35, 60-95) years and the cohort consisted of 22% (n=7) females. The ASA-class was ASA II (47%, n=15) or ASA III (53%, n=17). The majority of the injuries were the result of a low-energy trauma (78%, n=25) due to a simple fall (75%, n=24). Some patients sustained associated injuries, including chest injury (6%, n=2), major upper limb injury (6%, n=2), head injury (3%, n=1) and/or major lower limb injury (3%, n=1). The most common acetabular fracture patterns were anterior column + posterior hemitransverse (44%, n=14), followed by associated both column (25%, n=8) and anterior column (22%, n=7) (Fig. 2a). The majority of the patients had dome impaction (94%, n=30) as the surgical indication for THA rather than fracture fixation only. A total of 47% (n=15) of the patients were operated within 72 hours from hospital admission and the median length of stay at the hospital was 6 days (5, 2-30). The median follow-up time was 1122 (894, 376-2528) days (3.1 years). Additional patient and injury characteristics are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Patient characteristics, injury- and treatment-related variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eAge (years), median (IQR, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e77 (35, 60-95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eFemale gender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e7 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eASA-class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eASA II, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e15 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eASA III, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e17 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eMechanism of injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSimple fall, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e24 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eFall from height, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBicycle accident, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eAssociated injuries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eHead injury, n (%)\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eChest injury, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMajor upper limb injury, n (%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMajor lower limb injury, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eJudet-Letournel fracture type\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAnterior column, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e7 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePosterior wall, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAnterior column + posterior hemitransverse, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e14 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBoth columns, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e8 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eUnable to classify, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eIndication for THA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDome impaction, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e30 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePosterior wall injury, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eOperated within 72 hours, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e15 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eHospital length of stay (days), median (IQR, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e6 (5, 2-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were operated with a cemented primary THA with a Lubinus SPII stem (Waldemar Link, Hamburg, Germany) and a Lubinus SPII cup (n=3) or Marathon cup (n=29) (DePuy Synthes, Richmond, Virginia, USA). \u0026nbsp;The most common acetabular fracture fixation was a combination of an anterior plate with a reinforcement ring (50%, n=16) and the mostly used ring was a M\u0026uuml;ller ring (91%, n=29) (Zimmer Biomet, Warsaw, Indiana, US) (Fig. 2b). The hip prosthesis approaches used was an anterolateral (81%, n=26) or a posterior approach (19%, n=6), all in lateral decubitus position. The median perioperative blood loss was 700 ml (825, 300-1900). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReoperations occurred in two (6%) patients due to hip dislocation, where of one was operated by a posterior approach with a Burch-Schneider ring (Zimmer Biomet, Warsaw, Indiana, US) and the other by an anterolateral approach with a M\u0026uuml;ller ring. Both patients went through two closed reductions and subsequently underwent cup revision as the final treatment. Deep infection was detected in three patients (9%) with two of them occurring at least one year postoperatively, while the last one within the first week. Subsequently, all of them were treated with long term antibiotics only as one patient rejected surgery and two were judged to be too frail for further extensive revision surgery. Moreover, 22% (n=7) of the patients sustained at least one non-surgical complication which included four (13%) cases of pulmonary embolism, one (3%) case of pneumonia, one (3%) case of urinary tract infection and one (3%) patient with deep venous thrombosis (Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Type of fixation and in relation to fracture type\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 464px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFixation type (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFracture type (n\u003c/strong\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eRing + anterior plate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eRing + posterior plate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eRing + double plate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePosterior plate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAnterior column\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePosterior wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAnterior column + posterior hemitransverse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAssociated both column\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eUnable to classify\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSigns of stem loosening according to Gruen zones were observed in eight (25%) patients, with zone 1 as the most common area (n=6, 19%). Three (9%) patients showed multiple zones of radiolucency. In contrast, none of the patients showed signs of acetabular cup or reinforcement ring loosening in DeLee \u0026amp; Charnley zones. Heterotopic ossification was observed in 94% (n=30) of the patients with most of them being Brooker grade 1 (n=18, 56%), and only one patient (3%) with grade 4 (Table 3). \u0026nbsp; \u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u0026nbsp;Radiological findings of stem loosening (Gruen zones), cup/ring loosening (DeLee \u0026amp; Charnley zones), and heterotopic ossification (Brooker classification) at follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003eStem loosening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e6 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMultiple zones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003eCup/ring loosening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eZone 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003eHeterotopic ossification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eGrade 1 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e18 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e5 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eGrade 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e6 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eGrade 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median Harris hip Score for all patients was 87 (33, 33-100), which corresponds to good function. Fourteen patients (44%) were considered as excellent, 6 (19%) as good, 3 (9%) as fair, and 9 (28%) as poor. The median EQ-5D-3L index score for all patients was 0.7 (0.5, 0.0-1.0) where 63% (n=20) of the patients reported some difficulties to walk, 56% (n=18) some pain/discomfort, and 50% (n=16) some anxiety/depression. Among the patients that reported extreme difficulties, self-hygiene (n=4, 13%) and pain (n=4, 13%) were the most commonly affected domains (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA positive correlation between HHS and EQ-5D-3L index score was found (\u0026rho;=0.8, p=0.001, n=32), suggesting that higher HHS was associated with higher EQ-5D-3L index score (Fig. 3). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 \u0026nbsp;Overview of functional outcomes at follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eHarris Hip score, median (IQR, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e87 (33, 33-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExcellent (\u0026ge;90), n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e14 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eGood (80-89), n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e6 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eFair (70-79), n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePoor (\u0026lt;70), n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e9 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEQ-5D-3L index score, median (IQR, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.7 (0.5, 0.0-1.0).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eMobility\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo difficulty, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e10 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSome difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e20 (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExtreme difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eSelf-care\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo difficulty, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e21 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSome difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e7 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExtreme difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eUsual activities\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo difficulty, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e19 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSome difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e10 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExtreme difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003ePain/discomfort\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo difficulty, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e10 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSome difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExtreme difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cem\u003eAnxiety/depression\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo difficulty, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e16 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSome difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e16 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExtreme difficulties, n (%)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the functional and radiological outcomes of elderly acetabular fracture patients operated with internal fixation and acute THA, were investigated. The main findings were a good function and the absence of acetabular component loosening.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe fracture patterns and methods of combining fixation with THA among the patients were slightly heterogeneous. Most of the patients (n=31, 97%) were operated with a reinforcement ring in combination with or without additional plating. Despite this, none of the patients showed loosening of either the ring or the cup, even among patients followed up to 6.9 years postoperatively, which may suggest long-term durability of the acetabular component, as indicated by a previous report (7). Although radiolucency around the femoral stem was observed in 25% of the patients, most of them did not show engagement of multiple zones and therefore do not necessarily correlate with clinically significant loosening (16). HO was observed in 30 (94%) patients with 6 (19%) having grade 3 and 1 (3%) grade 4. No correlation between HO and HHS or EQ-5D-3L index score could be observed, which might be due to insufficient patient numbers or the fact that most patients only had a grade 1 HO.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe functional outcomes of this study align with previously reported results in the literature (17\u0026ndash;19). In a 2022 systematic review, McCormick et al. compared the outcomes of different treatments for acetabular fractures in the elderly by pooling thirty-eight studies (19). An average HHS of 85 (74-93) was reported among the ORIF+THA group, which was comparable to the results of this study. Furthermore, when compared to hip fracture patients operated with THA and similar follow-up time, the mean HHS was similar with a score of 87 (\u0026plusmn; 9.4) at 1 year postoperatively and 89 (\u0026plusmn; 8.1) at 4 years among the hip fracture patients in a 2011 RCT by Hedbeck et al. (20). In addition, the EQ-5D-3L score for both this study and the study by Hedbeck et al. was similar as they showed a score of 0.68 at 1 year and 4 years postoperatively. The correlation between the HHS and EQ-5D-3L in this study indicates a concordance between the values from the patients\u0026rsquo; self-reporting and those derived from the clinical examination. As many of the patients reported at least some pain/discomfort and anxiety/depression, it illustrates the importance of additional long term postoperative rehabilitation and care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, 22% of the patients had a non-surgical complication and 16% had a surgically related complication with 2 cases of hip dislocation. For comparison, McCormick et al. reported a complication rate of 25% for ORIF+THA patients, which was lower than for ORIF alone (38%) and with an OR of 1.87 (19). The rate of dislocations was comparable to a previous report on ORIF+THA patients where Basset et al. reported a 6% dislocation in a cohort of 51 patients (21). In contrast, Liang et al. reported up to 12% dislocations in a 2023 meta-analysis with a total of 255 patients (22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe major strengths of this study were the relatively long follow-up time with an average of approximately 3 years and the use of standardized assessments (e.g. HHS, EQ-5D-3L, radiographic classifications). There are some limiting factors, such as the single site design, patient-cohort size and the exclusion criteria. This in turn may skew the data towards examining only the patients that are motivated and healthy enough to attend the follow-up. As the complication rate was considerable, it is important to assess whether there are potential clinical factors for predicting adverse outcomes in patients that undergo ORIF+THA surgery. Furthermore, despite the absence of cup or reinforcement ring loosening, future studies to examine implant stability in a clinical setting is needed to evaluate if there is implant/fracture movement that could give rise to late subsequent implant loosening.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study suggests that internal fixation with acute THA among elderly may yield a good functional outcome with no signs of acetabular implant loosening.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHO; Heterotopic ossification.\u003c/p\u003e\n\u003cp\u003eHHS; Harris Hip Score.\u003c/p\u003e\n\u003cp\u003eORIF; Open reduction and internal fixation.\u003c/p\u003e\n\u003cp\u003eTHA; Total hip arthroplasty.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Swedish Ethical Review Authority, which is the national authority responsible for all ethical review in Sweden. The approval number is 2023-05170-01. All study participants have given written informed consent prior to participating in the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Promobilia (grant number A23117).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026acute;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DC and AE. Radiological data interpretation was performed by SK. The first draft of the manuscript was written by DC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLuigi Belcastro, for valuable contribution with patient coordination.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGary JL, Paryavi E, Gibbons SD, Weaver MJ, Morgan JH, Ryan SP, et al. Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma. 2015 Apr;29(4):202\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Toole RV, Hui E, Chandra A, Nascone JW. How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty? J Orthop Trauma. 2014 Mar;28(3):148\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eNavarre P, Gabbe BJ, Griffin XL, Russ MK, Bucknill AT, Edwards E, et al. Outcomes following operatively managed acetabular fractures in patients aged 60 years and older. Bone Joint J. 2020 Dec;102-B(12):1735\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eFerguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010 Feb;92(2):250\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002 Jan;84(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eTidermark J, Blomfeldt R, Ponzer S, S\u0026ouml;derqvist A, T\u0026ouml;rnkvist H. Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients. J Orthop Trauma. 2003 Mar;17(3):193\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eEnocson A, Blomfeldt R. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma. 2014 Jun;28(6):330\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eRickman M, Young J, Trompeter A, Pearce R, Hamilton M. Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing. Clin Orthop Relat Res. 2014 Nov;472(11):3375\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eLundin N, Berg HE, Enocson A. Complications after surgical treatment of acetabular fractures: a 5-year follow-up of 229 patients. Eur J Orthop Surg Traumatol. 2023 May;33(4):1245\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eR J, J J, E L. FRACTURES OF THE ACETABULUM: CLASSIFICATION AND SURGICAL APPROACHES FOR OPEN REDUCTION. PRELIMINARY REPORT. The Journal of bone and joint surgery American volume [Internet]. 1964 Dec [cited 2025 May 8];46. Available from: https://pubmed.ncbi.nlm.nih.gov/14239854/\u003c/li\u003e\n\u003cli\u003eHarris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eDolan P. Modeling valuations for EuroQol health states. Med Care. 1997 Nov;35(11):1095\u0026ndash;108. \u003c/li\u003e\n\u003cli\u003eBrooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973 Dec;55(8):1629\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eDeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;(121):20\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eGruen TA, McNeice GM, Amstutz HC. \u0026ldquo;Modes of failure\u0026rdquo; of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979 Jun;(141):17\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eKatzer A, L\u0026oelig;hr JF. Early loosening of hip replacements: causes, course and diagnosis. J Orthopaed Traumatol. 2003 Dec;4(3):105\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eDe Bellis UG, Legnani C, Calori GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury. 2014 Feb;45(2):356\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eIqbal F, Ullah A, Younus S, Aliuddin A, Zia OB, Khan N. Functional outcome of acute primary total hip replacement after complex acetabular fractures. Eur J Orthop Surg Traumatol. 2018 Dec;28(8):1609\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eMcCormick BP, Serino J, Orman S, Webb AR, Wang DX, Mohamadi A, et al. Treatment modalities and outcomes following acetabular fractures in the elderly: a systematic review. Eur J Orthop Surg Traumatol. 2022 May;32(4):649\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eHedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, T\u0026ouml;rnkvist H, Ponzer S, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am. 2011 Mar 2;93(5):445\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eBassett JW, Diamond OJ, Spence DJ, Ward AJ, Acharya MR, Chesser TJ. Mid-term results of the treatment of complex acetabular fractures with combined acute fixation and total hip replacement in the older patient. Hip Int. 2023 Nov;33(6):1093\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLiang K, Gani MH, Griffin X, Culpan P, Mukabeta T, Bates P. Acute versus delayed total hip arthroplasty after acetabular fracture fixation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2683\u0026ndash;93. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acetabular fracture, Elderly, Acute total hip arthroplasty, fix and replace, Harris Hip score, EQ-5D","lastPublishedDoi":"10.21203/rs.3.rs-7244718/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7244718/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eAcetabular fractures in elderly are associated with complex fracture patterns and poor bone quality. Internal fixation alone in these patients has been associated with poor outcome. Internal fixation combined with acute total hip arthroplasty (THA) is an approach to stabilize the acetabulum and restore hip function, however functional and radiological data are still limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;60 years with an acetabular fracture treated with acute THA and additional acetabular fixation were followed up at least one year postoperatively. All patients were treated from 2017 to 2023 at the Karolinska University Hospital within 21 days after trauma. Medical records were reviewed, functional examinations and radiographic assessment were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 32 patients were included. The median (IQR, range) age was 77 (35, 60\u0026ndash;95) years and 22% (n\u0026thinsp;=\u0026thinsp;7) were females. Dome impaction (94%, n\u0026thinsp;=\u0026thinsp;30) was the main indication for THA and the median follow-up time was 3.1 years. Two (6%) patients had a postoperative hip dislocation. Three (9%) patients had a deep infection and 22% (n\u0026thinsp;=\u0026thinsp;7) sustained at least one non-surgical complication. The median Harris Hip Score was 87 (33, 33.3\u0026ndash;100) and the median EQ-5D-3L index score was 0.7 (0.5, 0.0\u0026ndash;1.0). Heterotopic ossification was observed in 94% (n\u0026thinsp;=\u0026thinsp;30) of the patients, mostly Brooker grade 1 (n\u0026thinsp;=\u0026thinsp;18, 56%). No radiological signs of loosening of the acetabular reinforcement ring or the cup was observed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eInternal fixation with acute THA among elderly may yield a good functional outcome with no signs of acetabular implant loosening in this mid-term follow-up.\u003c/p\u003e","manuscriptTitle":"Functional and radiological outcomes in elderly acetabular fracture patients treated with internal fixation and acute total hip arthroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 06:57:53","doi":"10.21203/rs.3.rs-7244718/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee469d84-6a3e-46a4-a27b-f342ad32842e","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T07:24:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 06:57:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7244718","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7244718","identity":"rs-7244718","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}