Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre

Author:

Mancino Fabio12ORCID,Wall Ben1,Bucher Thomas A1,Prosser Gareth H1,Yates Piers J123,Jones Christopher W124

Affiliation:

1. Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia

2. The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia

3. University of Western Australia, Perth, WA, Australia

4. Curtin University, Perth, WA, Australia

Abstract

Background: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making. Methods: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant. Results: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions. Conclusions: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

Publisher

SAGE Publications

Reference36 articles.

1. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030

2. Periprosthetic fractures: the next fragility fracture epidemic? A national observational study

3. The Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty 2022 Annual Report, Adelaide. https://aoanjrr.sahmri.com/documents/10180/732916/AOA+2022+AR+Digital/f63ed890-36d0-c4b3-2e0b-7b63e2071b16 (2022, accessed May 15, 2023).

4. Long-Term Survival of the Cemented Exeter Universal Stem in Patients 50 Years and Younger: An Update on 130 Hips

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