Frail Patients Benefit From Less Invasive Procedures

Area of Science:

• Orthopedic surgery
• Geriatric trauma care
• Patient frailty assessment

Background:

• Periprosthetic fractures (PPFs) are a significant complication following total hip arthroplasty.
• Treatment decisions for PPFs must consider patient frailty, particularly in older adults.

Purpose of the Study:

• To evaluate the impact of surgical invasiveness on outcomes in frail patients with traumatic periprosthetic fractures.
• To determine if less invasive treatments improve postoperative results for frail individuals.

Main Methods:

• Retrospective analysis of 63 patients with periprosthetic fractures.
• Frailty assessed using the Complex Fracture Frailty Index (CFFI), incorporating comorbidities, labs, function, social, and cognitive factors.
• Primary outcomes included mortality, minor complications, and major complications (death, reoperation, immobility at 1 year).

Main Results:

• Frail patients (n=30) demonstrated lower survival rates (P=.014) and significantly more major complications (RR=3.7, P=.02).
• In frail patients, minimally invasive techniques (MITs) resulted in fewer major and minor complications compared to open reposition and internal fixation (ORIF) or revision.
• ORIF led to fewer minor complications than revision surgery (P=.015).

Conclusions:

• The Complex Fracture Frailty Index (CFFI) effectively identifies frail patients who have poorer survival outcomes.
• More invasive surgical approaches negatively impact treatment outcomes for frail patients with periprosthetic fractures.
• Assessing patient frailty is crucial for selecting the optimal surgical procedure for periprosthetic fractures.