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The aims of the study were (1) to determine the cumulative two to twenty-year survivorship of the hip after open reduction and internal fixation of displaced acetabular fractures, (2) to identify factors predicting conversion to total hip arthroplasty or hip arthrodesis, and (3) to create a predictive model that calculates an individual’s probability of early need for total hip arthroplasty or hip arthrodesis.Eight hundred and sixteen acetabular fractures treated with open reduction and internal fixation by one surgeon over a twenty-six-year period were analyzed. Cumulative two to twenty-year Kaplan-Meier survivorship analyses of the hip, including best and worst-case scenarios, were performed with total hip arthroplasty or hip arthrodesis as the end point. Univariate and multivariate Cox regression analyses were performed to identify negative predictors, which were then used to construct a nomogram for predicting an individual’s probability of needing an early total hip arthroplasty.The cumulative twenty-year survivorship of the 816 hips available for follow-up was 79% at twenty years. The best and worst-case scenarios corresponded to cumulative twenty-year survivorship of 86% and 52%, respectively. Significant independent negative predictors were nonanatomical fracture reduction, an age of more than forty years, anterior hip dislocation, postoperative incongruence of the acetabular roof, involvement of the posterior acetabular wall, acetabular impaction, a femoral head cartilage lesion, initial displacement of the articular surface of ≥20 mm, and utilization of the extended iliofemoral approach.Open reduction and internal fixation of displaced acetabular fractures was able to successfully prevent the need for subsequent total hip arthroplasty within twenty years in 79% of the patients. The results represent benchmark comparative data for any future and past studies on the outcome of surgical fixation of acetabular fractures.Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.