Surgeon Experience May Predict Failure After Revision Total Hip Arthroplasty for Periprosthetic Fracture

Periprosthetic fracture often requires revision hip arthroplasty. This study evaluated factors contributing to subsequent revisions and reoperations in patients who underwent revision hip arthroplasty for periprosthetic femur fracture. The authors hypothesized that surgeons who had higher revision volume would have decreased subsequent complications.

A retrospective review of 84 revision hip arthroplasties for Vancouver B2 periprosthetic femur fractures performed at a single academic institution was conducted. Surgeons were categorized based on their reoperation volume: experienced (≥ 12 complicated hip reoperations annually) and less experienced (< 12 complicated hip reoperations annually). Univariable and multivariable analyses evaluated risk factors for all-cause revision. Survival analyses were performed using Cox proportional hazard modeling.

Of the 84 patients, there were eight (10%) revisions and 15 (18%) reoperations. Survivorship free of all-cause revision was greater for high-volume surgeons [hazard ratio [HR] 0.03 (0.00 to 0.43); P = 0.01]. Subanalysis demonstrated that experienced surgeons had increased 5-year survivorship free of septic revisions [HR 0.03 (0.00 to 0.54); P = 0.02]. The multivariable analysis also demonstrated that extended oral antimicrobial prophylaxis was associated with 5-year septic reoperation-free survival [HR 0.03 (0 to 0.45); P = 0.01]; this only trended toward significance in 5-year septic revision-free survival [HR 0.04 (0.00 to 1.97); P = 0.11]. There was no association between aseptic revision and surgeon experience in univariable or multivariable analysis.

Experienced arthroplasty surgeons, as well as extended oral antibiotic prophylaxis, may improve patient outcomes when treating patients who have periprosthetic fractures requiring revision arthroplasty. Consideration should be given to call schedules and management of this vulnerable population.