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Risk Stratification in Periprosthetic Hip Fracture Surgery: The Risk Analysis Index Is Superior to the Five-Item
Nick Jowkar1, Maxwell Ruffner2, Victor Koltenyuk2
1The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, Vermont; REAM Orthopedics, Columbus, Ohio.
The Journal of Arthroplasty
|June 24, 2026
Summary
The Risk Analysis Index (RAI) better predicts mortality and non-home discharge after periprosthetic femoral fracture surgery compared to the Five-Item Modified Frailty Index (mFI-5). RAI can improve surgical planning and patient counseling for elderly orthopedic patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Periprosthetic femoral fractures (PFFs) are a significant complication of hip arthroplasty, leading to high mortality and substantial healthcare costs.
- Accurate preoperative risk assessment is crucial for managing PFFs and optimizing patient outcomes.
- Existing risk assessment tools require evaluation for their effectiveness in this specific patient population.
Purpose of the Study:
- To compare the predictive performance of the Risk Analysis Index (RAI) and the Five-Item Modified Frailty Index (mFI-5) for postoperative outcomes in patients undergoing surgery for PFFs.
- To determine if RAI or mFI-5 is a more effective tool for preoperative risk stratification in this patient group.
- To inform surgical decision-making and postoperative planning for PFF management.
Main Methods:
- A retrospective analysis of 824 patients who underwent surgery for PFF was conducted using a national surgical database.
- RAI and mFI-5 scores were calculated for all patients.
- Multivariable logistic regression models were used to assess the association between each index and outcomes, controlling for covariates. Predictive performance was evaluated using the area under the receiver operating curve (AUC).
Main Results:
- The RAI demonstrated superior predictive ability for mortality (AUC: 0.69 vs. 0.53) and non-home discharge (AUC: 0.71 vs. 0.57) compared to the mFI-5.
- In adjusted analyses, RAI was significantly associated with increased odds of mortality and non-home discharge.
- These findings highlight the differential predictive power of the two indices for critical postoperative outcomes.
Conclusions:
- The Risk Analysis Index (RAI) is a more effective tool than the Five-Item Modified Frailty Index (mFI-5) for predicting mortality and non-home discharge in patients with periprosthetic femoral fractures.
- Implementing RAI into clinical practice can enhance preoperative risk stratification for PFF patients.
- This improved risk assessment can significantly aid surgical planning and patient/family counseling, particularly for geriatric orthopedic patients.
