[Translated article] Mortality following periprosthetic and peri-implant femoral fractures: Comparative analysis according to previous implant type

Periprosthetic and peri-implant femoral fractures (PPF) include periprosthetic hip fractures (periPC), periprosthetic knee fractures (periPR), as well as peri-implant fractures associated with an osteosynthesis nail (periCL). Although risk factors for PPF are widely studied, there is scarce evidence on differential risk factors for each subtype. The objective of this study is to compare 30-day and 1-year mortality rates among the three PPF subtypes and identify differential risk factors between them.

A retrospective cohort study conducted in a tertiary hospital, including 100 patients with PPF between 2019 and 2022, with a minimum follow-up of one year. Demographic, clinical, and surgical data were collected, along with 30-day and 1-year mortality and changes in ambulation capacity. Statistical analysis included intergroup comparison tests and stratified mortality analysis.

There were 49 periprosthetic hip fractures, 29 knee fractures, and 22 femoral nail-related fractures. Overall mortality was 12% at 30 days and 28% at one year, with no differences between subtypes. Mortality was associated with ASA>III, CCI>5, systemic complications, intraoperative transfusions, and deterioration of ambulation capacity (p<.05). Stratified analysis identified significant differential associations in periPC (age, CCI>5, ASA>III, systemic complications, postoperative ambulatory status) and periPR (ASA, surgical time, systemic and local complications, ambulatory status), with no significant factors in periCL.

Elevated ASA index, CCI, and systemic complications are risk factors in all three types of PPF. Surgical time and local complications were associated with worse outcomes in the periPR group. Novel findings include the need for blood transfusions and deterioration of ambulatory status as modifiable risk factors associated with higher mortality.