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Mortality and functional outcomes following lower limb periprosthetic, peri-implant fractures - a 3-year experience
Zachary Chu1, Chen Zhang2, Claire Lee-Moeung3
1Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore.
Insights
Periprosthetic and peri-implant fractures (PPPIFs) have high mortality and complications. While surgery improves function, overall outcomes remain below pre-fracture levels, influenced by frailty.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Periprosthetic and peri-implant fractures (PPPIFs) are a growing concern with increased joint arthroplasty and fixation procedures.
- Understanding mortality, functional outcomes, and complications is crucial for managing these complex fractures.
Purpose of the Study:
- To investigate 12-month mortality, functional outcomes, and complication rates in patients with PPPIFs.
- To analyze the impact of primary implant location and management strategy on patient outcomes.
- To identify predictors of mortality and functional recovery in this patient population.
Main Methods:
- A three-year retrospective study of patients with PPPIFs at a tertiary institution.
- Primary outcome: 12-month mortality. Secondary outcomes: complication rates, functional recovery (Modified Barthel Index), and mobility.
- Multivariate analysis to determine predictors of mortality and functional outcomes.
Main Results:
- 15.6% 12-month mortality observed in 96 patients (mean age 82.6 years).
- Surgical management improved function (MBI increase) but increased complications compared to non-surgical approaches.
- Clinical Frailty Scale (CFS) significantly predicted mortality and functional recovery.
Conclusions:
- PPPIFs are linked to significant mortality and perioperative complications.
- Functional recovery was noted, but 12-month function did not reach pre-fracture levels.
- Frailty is a key factor in outcomes; implant location did not significantly impact results.
Background:
Periprosthetic and peri-implant fractures (PPPIFs) are increasingly prevalent due to the rising incidence of joint arthroplasty and fixation procedures. This study investigates 12-month mortality, functional outcomes, and complications associated with PPPIFs, focusing on the impact of the location of primary implant and the management approach.
Methods:
A three-year retrospective study was conducted on patients presenting with PPPIFs at a tertiary institution. Primary outcomes included 12-month mortality, while secondary outcomes assessed complication rates, functional recovery (Modified Barthel Index (MBI)) and mobility status. Multivariate analysis was used to identify predictors of mortality and functional outcomes.
Results:
Among 96 patients (mean age: 82.6 ± 8.1 years, 77.8% female), the 12-month mortality rate was 15.6%, with higher mortality in proximal fractures (17.6%) compared to distal fractures (12.5%). Surgical management was associated with greater functional improvements (mean MBI increase: 41.6 vs. 30.8, p = 0.033) but higher complication rates (35.8% vs. 12.5%, p = 0.030). Multivariate analysis identified the Clinical Frailty Scale as a significant predictor of both mortality (OR = 3.86, p = 0.009) and functional recovery (estimate = -4.72, p = 0.039).
Conclusion:
PPPIFs are associated with considerable 12-month mortality and perioperative complications. Although patients showed marked improvement from immediate post-fracture function, the mean 12-month function remained below pre-fracture levels. Surgical management was associated with greater improvements in functional status and increased perioperative complications. Poorer CFS was found to be negatively associated with both functional and mortality outcomes. Outcomes had no statistically significant difference based on the location of the primary implant.
