Risk Factors of Mortality in Patients With Periprosthetic Fractures: An Experience of 100 Cases

This study aims to determine the frequency and risk factors of mortality in patients with periprosthetic fractures.

A retrospective review was conducted on 100 patients with periprosthetic fractures around hip and knee replacements. Inclusion criteria were radiological evidence of fracture and age >65 years. Exclusions included prior surgically treated fractures, fractures due to malignancy, lost follow-up, or unavailable postoperative data. Patients were analyzed for postoperative fracture union, complications, and mobility status using clinical and radiographic data. Data were analyzed using R software version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria), employing chi-square and Mann-Whitney U tests for categorical and numerical data, respectively, with logistic regression to control for confounders.

The mean time to operation was 3.25 ± 1.11 days. Among 100 patients, the mean age was 82.22 ± 6.90 years, with a slight male predominance n = 58 (58%). Hip fractures were more common (n = 73; 73%), with knee fractures comprising n = 27 (27%). Most patients were treated at district general hospitals (DGHs) (n = 86; 86%). Mortality within six months was n = 17 (17%). No significant gender differences in mortality were found (p = 0.3). Age >81 years was associated with higher mortality (p = 0.04). Nonoperative management was linked to higher mortality (p = 0.003). No significant differences were observed between hip and knee fracture mortality rates (p = 0.8) or across fracture complexity (p = 0.5). Multivariate analysis indicated higher mortality for nonoperated patients (OR: 0.18, p = 0.004).

Age and operative management significantly impacted mortality in periprosthetic fractures. Older age (≥81 years) and nonoperative management were linked to higher mortality rates.