Periprosthetic femoral fractures are on the increase in the aging population. Conservative and operative management strategies are challenging with significant societal and health system cost. This study aims to investigate the pragmatic management of periprosthetic fractures in a large single centre cohort.
This is a retrospective cohort study of all femoral periprosthetic fractures around THR or TKR between 2014-2018 at our institute. Intraoperative fractures were excluded. We reviewed time to surgery, length of stay, survival, complications, classification and treatment (conservative, ORIF, or Revision surgery). Survival was assessed using Kaplan Meyer’s tests. SPSS version 24 was used with significance level 0.05.
172 patients were identified (60 male, 113 female) with median age 78 years (42-95). The majority of cases were treated by a senior surgeon (59/172) and the remaining patients were nearly equally distributed between 6 surgeons. 125 Peri hip replacement fractures were identified (5 uncemneted, 111 cemented THR and 9 hemiarthroplasty). 53 were revised, 65 received ORIF and 7 were treated conservatively. 38 Peri TKR had fixation while one had revision. 8 were between TKR and THR (received 2 revision and 6 ORIF). Average time to surgery was 3 days and length of stay was 25.6 days. The most common fracture was C3 (51.3%), B1 (16.6%) and B2 (16.6%). Complication rate was 5% (3 further fractures, 2 failure ORIF requiring revision, 2 ORIF failure treated conservatively, 2 infections and 2 dislocations). Average survival was 25.4 months (95% CI 23 to 27.4). Mortality was 7.5% at 3 months and 16.7% at 1 year.
Our unit pragmatic approach to treat patients by experienced surgeons showed low complication rate. There is significant mortality risk at 3 months and one year. Patients should be counselled on the risk of complications and survival.