Impact of fracture type on conversion to total hip arthroplasty following surgical repair of acetabular fractures: a systematic review and meta-analysis

Abstract Objectives: The objective of this study was to perform a meta-analysis of risk factors of conversion to total hip arthroplasty (THA) after operative fixation of acetabular fractures. Methods: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources included PubMed, MEDLINE, EMBASE, and Cochrane Library, which were screened from inception to 2024. Study Selection: Inclusion criteria were studies comparing risk factors of conversion to THA following acetabular fracture (OTA/AO 62A, B, C) surgical fixation. Data Extraction: Studies were assessed by the risk of bias and methodologic quality of evidence tools designed by the Cochrane Methods Bias Group and Cochrane Statistical Methods Group. Data Synthesis: Meta-analyses were conducted with a random-effects model using IBM SPSS Statistics Version 29.0.2.0. One-factor-at-a-time sensitivity analyses were conducted. Results: Twelve studies (1951 patients) were included. Based on the Judet and Letournel classification system, patients with associated fracture patterns were more likely to require conversion to THA than those with elementary patterns (risk ratio [RR] = 1.55, P = 0.013). Patients with posterior wall involvement (including posterior wall, posterior column with posterior wall, and transverse with posterior wall patterns) were more likely to require subsequent THA than those without posterior wall involvement (RR = 1.58, P < 0.001). Patients who presented with hip dislocation and acetabular dome impaction and comminution were at higher risk of THA (RR = 1.15 and 1.19, respectively; P < 0.001, both). Owing to heterogeneity in reported findings, there were insufficient data to assess the impact of the quality of reduction, restoration of the articular surface, time since acetabular fixation, and patient demographic factors on conversion to THA. Conclusions: This study aids in the identification of patients who may require early THA for posttraumatic arthritis based on fracture and injury patterns at presentation. Acetabular fractures with posterior wall involvement and those with associated fracture patterns are associated with a higher rate of conversion to THA. Injuries with acetabular dome impaction and comminution and hip dislocation are also significantly associated with conversion to THA. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.