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Published on: August 17, 2017
Mortality, Risk Factors and Risk Assessment after Periprosthetic Femoral Fractures-A Retrospective Cohort Study
Thaqif El Khassawna1, Gero Knapp2, Nadja Scheibler1,2
1Experimental Trauma Surgery, Faculty of Medicine, Justus-Liebig-University, 35392 Giessen, Germany.
Insights
Delayed surgery for periprosthetic femoral fractures (PFF) does not increase mortality. Charlson Comorbidity Index (CCI) predicts mortality risk better than American Society of Anesthesiologists (ASA) scores in PFF patients.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Fracture Care
Background:
- Periprosthetic femoral fracture (PFF) is a severe complication following hip arthroplasty.
- Understanding risk factors for mortality and functional outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the impact of surgical timing on mortality and postoperative outcomes in PFF patients.
- To compare the predictive value of Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) scores for PFF mortality.
Main Methods:
- Retrospective analysis of PFF patients treated between January 2010 and March 2018.
- Assessment of mortality rates, Harris Hip Score, and WOMAC score.
- Comparison of outcomes based on surgical delay (>48 hours), fixation methods (ORIF vs. revision arthroplasty), and comorbidity scores (CCI, ASA).
Main Results:
- One-year mortality rate after PFF was 10.7%.
- Delayed surgery (>48 hours) did not significantly impact mortality or functional outcomes.
- Higher CCI scores were associated with increased mortality, whereas ASA scores did not show significant differences.
- Cementation of the femoral stem correlated negatively with WOMAC scores.
Conclusions:
- Surgical delay beyond 48 hours is not a significant risk factor for mortality in PFF.
- The CCI is a more effective tool than the ASA score for assessing mortality risk in PFF patients.
- Optimal management strategies should consider patient comorbidities for improved outcomes.
Abstract:
Periprosthetic femoral fracture (PFF) is a devastating complication. Here, the authors aimed to determine the influence of the timing of surgery as a risk factor for mortality and poor postoperative outcome in patients suffering from PFF. A retrospective descriptive analysis of patients treated for PFF between January 2010 and March 2018 was performed. In addition to patient and treatment characteristics, we assessed mortality rates and postoperative functional outcome by using the Harris Hip and WOMAC score. One-year mortality after PFF was 10.7%. Delayed surgery after 48 h did not negatively influence mortality after PFF. The postoperative hospital stay did not influence the mortality rate, nor did it correlate with medical scores of comorbidities, general health or functionalities. Cementation of stem correlated negatively with the WOMAC score. Deceased patients had a higher Charlson Comorbidity Index (CCI) score, while American society of Anaesthesiologists (ASA) scores did not show a significant difference. There were no differences between ORIF and revision arthroplasty. In conclusion, delayed surgery after 48 h does not negatively influence mortality after PFF. The CCI seems to be a suitable tool to assess patients' risk for increased mortality after PFF, while the usually used ASA score is not able to achieve a relevant risk assessment.
