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Are periprosthetic hip fractures more severe than native hip fractures? A systematic review of outcomes and resource utilization

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

There is a paucity of data comparing periprosthetic hip fracture (PPHFx) outcomes and resource utilization to native fractures. Many surgeons consider periprosthetic hip fractures to be more severe injuries than native fractures. The aim of this systematic review is to characterize the outcomes of PPHFx and assess their severity relative to native hip fractures (NHFx).

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic review was conducted using Medline, Biosis, and Cinahl. Primary outcomes were time to surgery, length of stay (LOS), cost of management, disposition, complication rates, readmission rates, and mortality.

Results

14 articles (13,489 patients) from 2010 to 2018 were included in the study. Study quality was generally low. Patient follow-up ranged from 1 month to 3.2 years. LOS ranged from 5.2 to 38 days. US cost of management was best estimated at $53,669 ± 19,817. Discharge to skilled nursing facilities ranged from 64.5 to 74.5%. Time to surgery ranged from 1.9 to 5.7 days. Readmission rates ranged from 12 to 32%. Per Clavien–Dindo classification, 33.9% suffered minor complications; 14.3% suffered major complications. 1 month and 1 year mortality ranged from 2.9% to 10% and 9.7% to 45%, respectively.

Conclusion

Time to surgery and LOS were longer for PPHFx relative to NHFx. Complications’ rates were higher for PPHFx compared to NHFx. There is no evidence for differences in LOS, cost, discharge, readmission rates, or mortality between PPHFx and NHFx. These results may serve as a baseline in future evaluation of PPHFx management.

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Funding

The present study did not receive funding.

Author information

Authors and Affiliations

  1. Case Western Reserve University, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA

    Mitchell L. Thom, Robert J. Burkhart & Ramón A. Arza

  2. MetroHealth Main Campus Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Marsalis C. Brown

  3. Avon Richard E. Jacobs Health Center, 33100 Cleveland Clinic Blvd, Avon, OH, 44011, USA

    Glenn D. Wera

  4. Orthopaedic Surgery, Schulich School of Medicine and Dentistry, London, Canada

    Mitchell L. Thom

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  1. Mitchell L. Thom
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Correspondence to Mitchell L. Thom.

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Conflict of interest

The authors have no relevant conflicts of interests for the present study.

Ethical approval

No ethical approval was required as the present study only reviewed published studies.

Informed consent

Not applicable.

Review information

The present review was not registered. There is no prepared study protocol other than what is stated in the Methods.

List of studies included in review:

  • Boylan et al.

  • Cox et al.

  • Chitnis et al.

  • Fneelon et al.

  • Goudie et al.

  • Griffiths et al.

  • Haughom et al.

  • Jennison and Yarlagadda

  • Katz et al.

  • Matharu et al.

  • Phillips et al.

  • Reeves et al.

  • Toogood et al.

  • Zuurmond et al.

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Thom, M.L., Burkhart, R.J., Arza, R.A. et al. Are periprosthetic hip fractures more severe than native hip fractures? A systematic review of outcomes and resource utilization. Arch Orthop Trauma Surg 144, 1117–1127 (2024). https://doi.org/10.1007/s00402-023-05116-1

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