Management and outcomes of femoral periprosthetic fractures at the hip

Abstract

Aims The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. Methods This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression. Results In all, 417 fractures (77%) were managed operatively and 122 (23%) conservatively. The median time to surgery was four days (interquartile range (IQR) 2 to 7). Of those undergoing surgery, 246 (59%) underwent revision and/or fixation and 169 (41%) fixation alone. The surgical strategy used differed by Unified Classification System for PPF type, with the highest rate of revision in B2/B3 fractures (both 77%, 176/228 and 24/31, respectively) and the highest rate of fixation alone in B1- (55/78; 71%) and C-type (49/65; 75%) fractures. Cemented stem fixation (odds ratio (OR) 2.66 (95% confidence interval (CI) 1.42 to 4.99); p = 0.002) and B2/B3 fracture type (OR 7.56 (95% CI 4.14 to 13.78); p < 0.001) were predictors of operative management. The median length of stay was 15 days (IQR 9 to 23), 12-month reoperation rate was 5.6% (n = 30), and 30-day readmission rate was 8.4% (n = 45). The 30-day and 12-month mortality rates were 5.2% (n = 28) and 21.0% (n = 113). Nonoperative treatment, older age, male sex, admission from residential or nursing care, and sustaining the PPF around a revision prosthesis were significant predictors of an increased 12-month mortality. Conclusion Femoral hip PPFs have mortality, reoperation, and readmission rates comparable with hip fracture patients. However, they have a longer wait for surgery, and surgical treatment is more complex. There is a need to create a national framework for data collection for this heterogeneous group of patients in order to understand the outcomes of different approaches to treatment. Cite this article: Bone Joint J 2022;104-B(8):997–1008 .

Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip

“…In general, the majority of our population are elderly, frail, with similar mortality rates as the neck of femur fracture population, as previously suggested. 21 , 22 The most common UCS fracture subtype in our population was B2, denoting a loose stem with good bone stock, a finding that is consistent in multiple other studies. 17 , 23 , 24 Pain prior to sustaining a PPF, which may possibly correlate with stem loosening, was most prevalent in patients that sustained a B2 and B3 fracture.…”

Periprosthetic femoral fractures around the original cemented polished triple-tapered C-stem femoral implant: a consecutive series of 500 primary total hip arthroplasties with an average follow-up of 15 years

“…National joint registries now provide the majority of arthroplasty outcome data, but with the exception of the Swedish Hip Arthroplasty Registry, capture only those patients in whom a complication has necessitated revision surgery [ 10 , 11 ]. In the case of PFF, this will not include fractures treated by ORIF or non-operatively due to patient frailty, and in a recent study of 539 PFFs, 23% (122 PFFs) were managed non-operatively, 31% (169 PFFs) by ORIF alone and 46% (246 PFFs) by ‘revision and/or fixation’ [ 27 ].…”