Analysis of predictive factors for hip osteoarthritis developing after acetabular fractures

Objective: This study aimed to reduce the risk of post-traumatic hip osteoarthritis, one of the most important long-term complications after surgery, by determining predictive factors in patients who underwent open reduction and internal fixation due to acetabular fractures, thus minimizing the need for re-surgery and improving quality of life. Materials and Methods: Patients who underwent open reduction and internal fixation after acetabular fractures were included in the study. Patients were followed up clinically and radiologically for at least two years, and variables such as age, time to surgery, fracture type, and surgical approach were examined in terms of osteoarthritis development. Results: Of the patients included in the study, 94 were male (72.3%) and 36 were female (27.7%), and the mean age was 42.8±13.5 years.The most common mechanism of trauma was motor vehicle accidents (58.5%), followed by falls from heights (28.5%). The most common fracture type was posterior wall fractures (22.3%), followed by double-column fractures (14.6%). With a minimum two-year follow-up, the rate of developing osteoarthritis was 21.6% in young adults and 33% in older adults. A significant association was observed between the development of osteoarthritis and older age (≥40 years) (p=0.002), but this association was not confirmed as an independent risk factor in multivariate analyses. Prolonged time to surgery was significantly associated with the development of osteoarthritis (p<0.001). Among fracture types, posterior wall fractures (p=0.02) and transverse fractures (p=0.04) constituted the highest risk group for osteoarthritis, and the Kocher– Langenbeck approach also stood out as an independent risk factor (p<0.001). The quality of surgical reduction was found to be an independent predictive factor (p<0.001). Conclusion: Posttraumatic osteoarthritis following acetabular fractures is a significant complication that causes persistent pain and functional limitations despite surgical treatment. The findings of this study demonstrate that the type of fracture (especially fractures involving the posterior wall and transverse) and the quality of reduction are determinants of osteoarthritis development. Furthermore, prolonged time to surgery and the preference for a posterior approach are also factors that increase risk. Early intervention in surgical planning, selection of the correct surgical approach, and meticulous anatomic reduction are critical for improving long-term functional outcomes and reducing the need for secondary surgery. Keywords: Acetabular fractures, Kocher–Langenbeck approach, Post-traumatic hip osteoarthritis, Posterior wall fracture