title: Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures.
abstract: BACKGROUND
  The aims of the study were (1) to determine the cumulative two to twenty-year survivorship of the hip after open reduction and internal fixation of displaced acetabular fractures, (2) to identify factors predicting conversion to total hip arthroplasty or hip arthrodesis, and (3) to create a predictive model that calculates an individual's probability of early need for total hip arthroplasty or hip arthrodesis.
  
  
  METHODS
  Eight hundred and sixteen acetabular fractures treated with open reduction and internal fixation by one surgeon over a twenty-six-year period were analyzed. Cumulative two to twenty-year Kaplan-Meier survivorship analyses of the hip, including best and worst-case scenarios, were performed with total hip arthroplasty or hip arthrodesis as the end point. Univariate and multivariate Cox regression analyses were performed to identify negative predictors, which were then used to construct a nomogram for predicting an individual's probability of needing an early total hip arthroplasty.
  
  
  RESULTS
  The cumulative twenty-year survivorship of the 816 hips available for follow-up was 79% at twenty years. The best and worst-case scenarios corresponded to cumulative twenty-year survivorship of 86% and 52%, respectively. Significant independent negative predictors were nonanatomical fracture reduction, an age of more than forty years, anterior hip dislocation, postoperative incongruence of the acetabular roof, involvement of the posterior acetabular wall, acetabular impaction, a femoral head cartilage lesion, initial displacement of the articular surface of ≥ 20 mm, and utilization of the extended iliofemoral approach.
  
  
  CONCLUSIONS
  Open reduction and internal fixation of displaced acetabular fractures was able to successfully prevent the need for subsequent total hip arthroplasty within twenty years in 79% of the patients. The results represent benchmark comparative data for any future and past studies on the outcome of surgical fixation of acetabular fractures.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland. moritz.tannast@insel.ch
authors.forename: Moritz
authors.initials: M
authors.lastname: Tannast
authors.forename: Soheil
authors.initials: S
authors.lastname: Najibi
authors.forename: Joel M
authors.initials: JM
authors.lastname: Matta
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors