Acute cemented total hip arthroplasty combined with open reduction and internal fixation for elderly acetabular fractures: a two-center retrospective cohort study

PURPOSE: The aim of this study was to evaluate the outcomes of cemented total hip arthroplasty (C-THA) combined with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures, focusing on immediate postoperative stability and functional recovery. METHODS: A retrospective cohort study was conducted on 51 patients with displaced acetabular fractures aged 60 years or older. Patients were divided into two groups: the C-THA group (n = 10) and the ORIF group (n = 41). Surgical procedures and outcomes, including time to full weight bearing (t-FWB), operative time, blood loss, Harris Hip Score (HHS at 3 months), poor prognostic factors (PPF), and complications were analyzed. RESULTS: The C-THA group achieved significantly earlier weight-bearing (median 3.9 (2.8-5) vs. 70 (63–70) days, p < 0.001) and a trend toward lower blood loss (median 914 vs. 1300 ml, p = 0.060). PPFs were more common in the C-THA group (3.50 vs. 2.00, p = 0.025). While HHS at 3 months showed no statistically significant difference, trends favored C-THA. Bone union was achieved in all patients. CONCLUSION: C-THA may provide stable fixation allowing for immediate full weight-bearing and may be a preferable option in elderly patients with poor prognostic factors. Further long-term studies are needed to confirm these findings.