Periprosthetic Fractures around Total Hip Replacement-Is There a Rush to Fix?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Arthroplasty

Background:

• Periprosthetic fractures are a significant complication of total hip replacement (THR), accounting for 14.1% of hip revisions.
• Current UK guidelines suggest early surgery for these fractures, but evidence is lacking.
• Surgery for periprosthetic fractures is complex, often requiring specialized implants and surgeons, leading to frequent delays.

Purpose of the Study:

• To analyze the impact of surgical delays on outcomes for patients with periprosthetic fractures around a THR.
• To compare outcomes between open reduction internal fixation (ORIF) and revision THR for periprosthetic fractures.
• To evaluate the relationship between time to surgery and length of stay, mortality, and complications.

Main Methods:

• Retrospective review of 88 patients undergoing surgery for periprosthetic fractures around a THR between 2012 and 2019.
• Data collected included risk factors, length of stay (LOS), and time to surgery.
• Regression analysis was used to analyze collected data.

Main Results:

• Revision THR surgery was more likely to be delayed than ORIF (median 143 h vs. 120 h, p=0.04).
• Median LOS was significantly longer for delayed surgery (27 days) compared to early surgery (17 days, p<0.0001).
• No significant increase in 90-day mortality, HDU admission, or perioperative complications was observed with delays beyond 72 hours.

Conclusions:

• Periprosthetic fractures necessitate specialized surgical approaches.
• Delayed surgery for periprosthetic fractures does not increase mortality or complications but significantly increases length of stay.
• Further multicenter research is needed to establish optimal surgical timing and management strategies.