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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Orthopaedic Science
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty.Injury. 2015 Feb; 46: 292-298
- Do mortality and complication rates differ between periprosthetic and native hip fractures?.J Arthroplasty. 2018 Jun; 33: 1914-1918
- Mid-term results of 121 periprosthetic femoral fractures: increased failure and mortality within but not after one postoperative year.J Arthroplasty. 2015 Apr; 30: 669-674
- Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register.J Arthroplasty. 2005 Oct; 20: 857-865
- Periprosthetic fractures: epidemiology and future projections.J Orthop Trauma. 2011 Jun; 25: S66-S70
- Mortality after periprosthetic fracture of the femur.J Bone Joint Surg Am. 2007 Dec; 89: 2658-2662
- Outcomes and predictors of mortality following periprosthethic proximal femoral fractures.Injury. 2019 Feb; 50: 438-443
- Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures.Injury. 2013 Dec; 44: 1949-1952
- Mortality following surgical management of vancouver B periprosthetic fractures.J Orthop Trauma. 2017 Jan; 31: 9-14
- The excess mortality due to periprosthetic femur fracture. A study from the Swedish national hip arthroplasty register.Bone. 2007 May; 40: 1294-1298
- Survivorship after periprosthetic femur fracture: factors affecting outcome.J Arthroplasty. 2016 Jun; 31: 1283-1288
- Mortality in patients sustaining a periprosthetic fracture following a hemiarthroplasty.J Orthop. 2018 May 7; 15: 798-801
- Assessment of morbidity and mortality after periprosthetic hip fracture. Influence of Vancouver stage in a retrospective single-centre study of 88 patients.Orthop Traumatol Surg Res. 2022 Feb; 108102985
- Analysis of mortality after surgical treatment of periprosthetic distal femur fractures.Rev Española Cirugía Ortopédica Traumatol. 2020 Mar-Apr; 64 ([English, Spanish]): 92-98
- Obesity: preventing and managing the global epidemic. Report of a WHO consultation.World Health Organ Tech Rep Ser. 2000; 894: 1-253
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994 Nov; 47: 1245-1251
- Charlson comorbidity index adjustment in intracerebral hemorrhage.Stroke. 2011 Oct; 42: 2944-2946
- High mortality rate following periprosthetic femoral fractures after total hip arthroplasty. A multicenter retrospective study.Injury. 2021 Oct; 52: 3022-3027
- Fractures of the femur after hip replacement.Instr Course Lect. 1995; 44: 293-304
- Results of new policies for inpatient rehabilitation coverage in Japan.Neurorehabilitation Neural Repair. 2011 Jul-Aug; 25: 540-547
- Risk factors for second hip fractures among elderly patients.J Orthop Sci. 2010 Mar; 15: 192-197
- Sarcopenia and mortality among older nursing home residents.J Am Med Dir Assoc. 2012 Feb; 13: 121-126
- Trajectories of lower extremity physical performance: effects on fractures and mortality in older women.J Gerontol A Biol Sci Med Sci. 2016 Dec; 71: 1609-1615
- The effect of different measurement modalities in the association of lean mass with mortality: a systematic review and meta-analysis.Osteoporos Sarcopenia. 2021 Mar; 7: S13-S18
- Introduction of a new treatment algorithm reduces the number of periprosthetic femoral fractures after primary total hip arthroplasty in elderly females.J Arthroplasty. 2020 Dec; 35: 3613-3620
- Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty.EFORT Open Rev. 2022 Aug; 7: 533-541
- Treatment algorithm of periprosthetic femoral fracturens.Geriatr Orthop Surg Rehabil. 2022; 1321514593221097608
- Prognostic factors for mortality after hip fracture: operation within 48 hours is mandatory.Injury. 2016; 47: S91-S97
Published online: January 18, 2023
Accepted: December 21, 2022
Received in revised form: December 12, 2022
Received: November 2, 2022
Publication stageIn Press Corrected Proof
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.