Mortality, Risk Factors and Risk Assessment after Periprosthetic Femoral Fractures-A Retrospective Cohort Study.

Thaqif El Khassawna,Nike Walter,Volker Alt,Markus Rupp,Nadja Scheibler,Gero Knapp,Christian Heiss,Deeksha Malhan,Christoph Biehl

doi:10.3390/jcm10194324

Abstract

Periprosthetic femoral fracture (PFF) is a devastating complication. Here, the authors aimed to determine the influence of the timing of surgery as a risk factor for mortality and poor postoperative outcome in patients suffering from PFF. A retrospective descriptive analysis of patients treated for PFF between January 2010 and March 2018 was performed. In addition to patient and treatment characteristics, we assessed mortality rates and postoperative functional outcome by using the Harris Hip and WOMAC score. One-year mortality after PFF was 10.7%. Delayed surgery after 48 h did not negatively influence mortality after PFF. The postoperative hospital stay did not influence the mortality rate, nor did it correlate with medical scores of comorbidities, general health or functionalities. Cementation of stem correlated negatively with the WOMAC score. Deceased patients had a higher Charlson Comorbidity Index (CCI) score, while American society of Anaesthesiologists (ASA) scores did not show a significant difference. There were no differences between ORIF and revision arthroplasty. In conclusion, delayed surgery after 48 h does not negatively influence mortality after PFF. The CCI seems to be a suitable tool to assess patients’ risk for increased mortality after PFF, while the usually used ASA score is not able to achieve a relevant risk assessment.

Highlights

Periprosthetic femoral fractures (PFF) represent an increasing challenge in orthopedic surgery
The mortality rate after PFF is up to 10% in the first 30 days; Bhattacharyya and colleagues showed a rate of 11% mortality in the first year after surgical treatment [5,6]
Does a longer time between hospitalisation and surgery lead to a higher postoperative mortality rate or a worse physical outcome? we evaluated whether the American Society of Anaesthesiologists (ASA) score and the Charlson Comorbidity Index (CCI) provide an adequate tool to assess mortality risk in often severely morbid and elderly patients who underwent surgical treatment for PFF

Summary

Introduction

Periprosthetic femoral fractures (PFF) represent an increasing challenge in orthopedic surgery. Due to the continuing increase in the number of total endoprostheses, a further increase in the incidence of patients with periprosthetic femur fractures is to be expected. It is a rare disease with a current incidence between 1% and 2.3% depending on the source, PFF is a tremendous challenge for both the surgeon and the patient [1,2]. In the case of a fixed femoral stem with osteosynthesis, the treatment with open reduction and internal fixation (ORIF) can preserve the prosthesis [7], whereas the ORIF results in a significantly increased failure rate when treating fractures around a loose stem [8,9]. A correlation between a high CCI and outcomes after surgery is controversial in the literature [10,11]

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Conclusion