This single‑centre prospective cohort study evaluates a novel “less invasive combined hip procedure” (LICHP), integrating navigated percutaneous anterior and posterior column screw fixation with total hip arthroplasty (THA) though a direct anterior approach (DAA) for non‑reconstructable native and periprosthetic acetabular fractures in geriatric patients. The technique aims to minimize surgical burden while enabling immediate unrestricted weight bearing, a key determinant of outcomes in frail older adults.
Between 2020 and 2025, 52 hips in 51 patients with a median age 85 years were treated. Fracture patterns were complex, comprising 58% native acetabular fractures and 42% periprosthetic fractures. The navigated technique allowed accurate placement of the column screws without requiring anatomical fracture reduction. The screws were intended to provide a buttressing effect for the subsequent acetabular reconstruction.
Median intraoperative blood loss was 600 mL, comparable to elective THA through a direct anterior approach, and median operating time was 255 minutes. Thirtyday mortality was 10%, reflecting the frailty and high perioperative risk of this cohort. Radiographic follow‑up was available for 75% of the hips and demonstrated a stable cup in 95%, with cup loosening observed in two cases and revision required in one. Functionally, 69% of patients returned to their preinjury living situation and 65% regained their pre-traumatic walking ability. PROMs at a median follow-up of 12 months showed favourable outcomes (EQ‑5D‑5L index 0.90; Forgotten Joint Score 90), comparable to normative values for older adults.
Overall, LICHP appears to offer a safe and effective surgical treatment option for non‑reconstructable geriatric acetabular fractures, enabling early mobilization with acceptable morbidity. The study supports broader consideration of navigated percutaneous fixation combined with THA, though controlled comparative studies are needed to refine indications and long‑term outcomes.
Interview with Dr. med. Lara Pozzi and Prof. Dr. Christoph Meier (both Winterthur)
What inspired you to conduct this study?
After introducing LICHP at our institution, we observed encouraging postoperative courses, both during the initial hospital stay and at follow-up. In particular, many of these frail patients seemed to regain mobility and independence despite their complex injuries. This prompted us to investigate whether our clinical impression could be confirmed objectively.
Were there any unexpected findings?
We were particularly surprised by the very low rate of hip instability in this high-risk patient group. Only one patient developed an unstable hip, and this occurred after revision surgery for periprosthetic joint infection. We believe that the direct anterior approach (DAA) used for THA may have contributed to this finding, as it allows for cup placement under intraoperative fluoroscopic control.
What is the direct impact on the surgeon’s work?
LICHP has become our standard procedure for non-reconstructable acetabular fractures in geriatric patients whenever safe placement and stable anchorage of the column screws are possible. With increasing experience in navigated column screw placement, we have also expanded the use of this technique to selected undisplaced acetabular fractures. In these cases, percutaneous screw fixation may either be combined with subsequent THA using a press-fit cup or used alone to provide sufficient stability for early unrestricted weight bearing.
What is your learning point from this project?
One of the main lessons from this project is that, although LICHP provides a stable construct allowing immediate unrestricted weight bearing, these patients remain a very frail population with substantial morbidity and mortality. Importantly, four of the six revisions in our cohort were due to periprosthetic joint infection. These infections proved tob e particularly challenging to treat in the presence of a large reconstruction with substantial foreign material. Therefore, minimising the risk of infection remains a major concern when treating these patients.
Are there any subsequent projects planned?
We have already used the same concept in selected patients with pathological acetabular fractures and plan to analyse this subgroup once a sufficiently large cohort is available. We are also considering further technical modifications to simplify the procedure. One option is to perform THA without transferring the patient to a traction table, thereby avoiding intraoperative repositioning. This could shorten operating time and potentially reduce blood loss and perioperative complications.
