Abstract
PURPOSE: To compare early postoperative results for the management of acetabular fractures using open reduction and internal fixation versus acute total hip replacement with a cementless modular cup in patients older than 55 years. METHODS: This was a retrospective cohort study conducted at a Level I trauma center between April 2019 and March 2024, including 36 consecutive patients aged ≥ 55 years with displaced acetabular fractures treated by a single senior pelvic surgeon using open reduction and internal fixation (n = 20), stand-alone total hip replacement (n = 9), or a planned two-stage combined hip procedure (n = 7). The primary outcome included Harris Hip Score at 6 months, Secondary outcomes included postoperative complications, unplanned reoperation, and radiographic implant assessment. RESULTS: At six months, both replacement groups showed significantly better functional outcomes (mean Harris hip scores of 83 and 82) compared to the fixation-only group (mean score of 57; p < 0.001). All reoperations (4/20) occurred in the fixation group, while no reoperation was required in the replacement groups. Radiographic evaluation confirmed stable implant fixation in all arthroplasty cases, without signs of loosening or dislocation. CONCLUSION: According to our treatment algorithm, acute total hip replacement using a modular revision cup with an iliac peg, with or without plate osteosynthesis, offers the advantage of early full weight-bearing and promising functional outcomes in the management of complex acetabular fractures. These results support the integration of acute total hip replacement into structured decision-making protocols especially for elderly patients.