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Periprosthetic Femoral Fractures and Their Surgical Outcomes Between 2011 and 2021: A Single-Centre Observational
Paul J Baggott1, Mohamed Zubair Farook1, Matthew Pritchard1
1Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, GBR.
Insights
Periprosthetic femoral fractures (PFFs) are increasing, particularly in older patients with comorbidities. Revision surgery for proximal PFFs showed lower mortality than fixation, suggesting improved outcomes.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Arthroplasty Complications
Background:
- Periprosthetic femoral fractures (PFFs) pose a growing healthcare challenge due to an aging population and increased joint replacement surgeries.
- Understanding PFF outcomes is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To analyze the trends and outcomes of PFFs over a 10-year period in a district general hospital.
- To investigate the impact of fracture location and surgical management on patient outcomes, including complications and mortality.
Main Methods:
- A retrospective observational study of 214 PFF cases between January 2011 and March 2021.
- Data collected included patient demographics, American Society of Anesthesiologists (ASA) scores, time to operation, length of stay, complications, and mortality.
- Analysis focused on variations based on fracture site and operative approach.
Main Results:
- PFF incidence rose, with a significant increase in patients having ASA scores of 3 or more (43% to 73%).
- Proximal PFF revision cases had longer hospital stays compared to proximal PFF fixation.
- Overall 30-day, 90-day, and one-year mortality rates were 6%, 10%, and 15%, respectively.
Conclusions:
- A notable increase in PFF incidence among patients with multiple comorbidities was observed over the decade.
- Revision procedures for proximal PFFs were associated with lower mortality rates compared to fixation.
- Findings on demographics, complications, and mortality align with those reported in international studies.
Abstract:
Introduction Periprosthetic femoral fractures (PFFs) present a significant burden on the health service. The incidence continues to rise globally as a result of an ageing population and an increase in the number of primary hip and knee arthroplasties being performed. This is a 10-year, retrospective, observational study that aims to better understand the outcomes of PFF in our district general hospital. Materials and methods We identified the demographic information of patients who had a PFF and looked at how the American Society of Anesthesiologists (ASA) score, time to operation, length of stay, complications, and mortality data vary depending on where the fracture is sited and the operative management employed. Results During the period between January 2011 and March 2021, we identified 214 cases of PFF. The mean age was 82.5 years with a female preponderance of 76%. Between 2011-2016 and 2017-2021, the number of cases of PFF increased and patients with an ASA score of 3 or more increased from 43% to 73%. Length of stay was longer in the proximal PFF revision group than in the proximal PFF fixation group. Overall PFF mortality rates at 30 days, 90 days, and one year were 6%, 10%, and 15%, respectively. Conclusion Over the 10-year period, there was a significant increase in the incidence of patients presenting with PFF with multiple comorbidities. Mortality rates were lower in proximal PFF patients who underwent revision procedures rather than fixation. The patient demographics, complication rates, and mortality rates were comparable to similar studies across different countries.
