High mortality rate following periprosthetic femoral fractures after total hip arthroplasty. A multicenter retrospective study

Abstract

The main objective of this study was to evaluate the morbidity and mortality following periprosthetic femoral fractures (PFFs) after total hip arthroplasty. The secondary objectives were to explore risk factors for mortality and compare outcomes by method of treatment. A multicenter retrospective study was conducted (2016-2017) of all PFFs after total hip arthroplasty. We collected data on: ASA score, Charlson comorbidity index, type of fracture, method of treatment, timing of surgery, length of stay, systemic and local complications and mortality. Functional outcome was assessed in terms of preoperative and postoperative ambulatory status. Univariate and multivariate analysis were performed in the sample to identify risk factors for mortality. A total of 107 patients were evaluated and their mean age was 81 years old. The most common type of fracture according to the Vancouver classification was B1 (52.4% of patients), followed by B2 fractures (31.8%). The mortality rate during the first month was 9.3% and was associated with patients with ASA >3. Mortality rate in the first year was 22.3% and was associated with poorer walking ability before surgery and Charlson index ≥3. In the multivariable analysis, Charlson index ≥3 (odds ratio=6.85) and age ≥80 years old (odds ratio=7.446) were associated with 1-year mortality. Neither complications nor mortality rate were associated with either time to surgery or method of treatment. More than half of the patients (57.9%) did not regain their prefracture walking status. Major systemic complications developed in 23.4% of the patients and major local complications in 12.1%. Despite modern surgical techniques and multidisciplinary management, this study highlights the ambulatory status impairment and high rate of complications and mortality after PFF. Although the mortality rate during the first year was similar to that observed in other studies on PFFs, we found a higher mortality rate within the first month.