Isolated Femoral Component Revision Outcomes in the Setting of Acute Periprosthetic Femoral Fractures

While periprosthetic femoral fracture (PFF) is not the most common reason for revision of a primary total hip arthroplasty (THA), it represents a common problem in the acute postoperative period. During this time, undergoing revision surgery has been found to have increased risks of complications. The goal of this study was to evaluate the outcome of patients who experienced an isolated femoral revision for a PFF acutely after primary THA.

We performed a retrospective chart review of patients from 2004 to 2022 using an institutional database. We included patients who underwent revision THA for a PFF within 8 weeks of their primary THA and had at least 1 year of follow-up. There were 49 patients who met the inclusion criteria and had an average follow-up of 5.5 years (range, 1.1 to 19.3). The mean age of the cohort was 67 years (range, 44 to 85), the mean body mass index was 31.9 (range, 19.7 to 57.4), 69.4% were women, and the mean American Society of Anesthesiologists score was 2.7 ± 0.5. Primary outcome measures were the incidence of postoperative complications and revision surgery. Medical complications, hospital readmissions, and mortality were also evaluated.

There were 10 patients in the cohort who suffered postoperative complications (20.4%), and nine of those patients (18.4%) underwent additional revision THA surgery. Of those additional revision cases, five patients (10.2%) developed acute periprosthetic joint infections and four patients (8.2%) developed signs of additional PFF or evidence of femoral stem subsidence and loosening. There were five mortalities (10.2%) unrelated to surgery in the subsequent years after acute PFF.

Patients undergoing isolated femoral component revision surgery in the setting of acute PFF after primary THA are at high risk of complications and reoperation.