Abstract
Background
Periprosthetic femoral fracture (PFF) after total hip arthroplasty (THA) or bipolar
hip arthroplasty (BHA) represents a challenging situation and the treatment is associated
with high rates of complications and mortality. The aims of this multicenter retrospective
study were to determine 1-year mortality and to identify predictors associated with
mortality, including patient characteristics and surgical factors, in patients undergoing
surgery for PFF after THA or BHA.
Methods
We collected 249 cases of PPF after THA or BHA that were treated in our 11 hospitals
(named the TRON group) between January 2010 and December 2019. We excluded patients
who were conservatively treated, cases in which the 1-year postoperative outcome was
unknown, and Vancouver type A cases. Finally, we analyzed 161 patients. Univariate
and multivariate Cox regression analyses were performed to identify factors affecting
1-year mortality. Patient-side factors such as age, BMI, fracture type, and preoperative
mobility, and surgical factors such as surgical procedure, time to surgery, and operation
time were analyzed respectively.
Results
Eighteen of 161 patients (11.2%) died one year after surgery. The multivariate Cox
regression analysis identified older age, wheelchair status before injury, and operation
time as independent predictors of 1-year mortality (older age: hazard ratio [HR] 1.07,
95% CI 1.01–1.15, P = 0.048; wheelchair status: HR 5.82, 95% CI 1.01–33.47, P = 0.049;
operation time: [HR] 1.01, 95% CI 1.00–1.01, P = 0.00929). Meanwhile, fracture type
according to the Vancouver classification, body mass index, presence of previous fragility
fractures, type of fixation, blood loss during operation, and time to surgery were
not independent predictors of 1-year mortality in this analysis.
ConclusionThe 1-year mortality rate after surgery for PPFs patients was 11.2%. Factors
associated with older and poor activity of daily living (ADL) performance (e.g., wheelchair
status before injury), and longer operative time were associated with 1-year mortality
after surgery for PPF. Surgeons should carefully plan treatment according to each
patient's condition.
Keywords
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Article info
Publication history
Published online: January 18, 2023
Accepted:
December 21,
2022
Received in revised form:
December 12,
2022
Received:
November 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
