Reported outcomes for patients following postoperative periprosthetic femoral fractures : a systematic review

Postoperative periprosthetic femoral fracture (POPFF) is an increasingly common and morbid complication of arthroplasty. This review aims to determine what outcomes are reported for POPFF and how they are measured, to inform the development of a core outcome set.

Systematic searches of major databases and clinical trial registries (June 2014 to May 2024) identified studies reporting outcomes for more than five POPFF patients in English or Chinese. Multiple reviewers performed study screening and data extraction. Outcomes were extracted verbatim, collapsed into outcome domain subcategories, and categorized. Outcomes were synthesized descriptively, with subgroup exploration by implant (hip/knee) and economic setting.

A total of 564 studies, comprising 119,445 POPFF patients (mean age 75.0 years (38.5 to 90.0); median percentage of female patients 61.8%), were included. Across the studies, 2,711 individual reported outcomes were collapsed into 671 unique terms within 59 outcome domain subcategories. Outcome reporting was dominated by the physiological/clinical core area (38.7%), followed by life impact (29.3%), resource use (12.8%), adverse events (11.7%), and death (7.6%). The most frequently reported subcategories were bone union/healing, surgical complications, component/prosthesis outcomes, hip function, and mortality/survival. Only 46.4% of outcomes were accompanied by a clear definition or named outcome measurement instrument; for bone union, just 7.4% provided a clear definition, 44.9% were vague, and 47.7% provided none. Health-related quality of life was measured in 6.9% of studies (39 instances) using seven instruments, most commonly the 12/36-Item Short-Form Health Survey questionnaire and EuroQol five-dimension questionnaire. Patterns varied between hip and knee POPFF and between high-income and low- to middle-income settings; one-year mortality was the most frequently reported survival timepoint.

Outcome reporting after POPFF is heterogeneous, clinician-centred, and frequently undefined, with sparse use of patient-reported outcome measures and health-related quality of life instruments. These findings support the development of a POPFF core outcome set and recommended outcome measurement instruments to standardize reporting and promote patient-centred research.