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Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties

  • Georgios Orfanos
  • Justin Lim
  • Bishoy Youssef
Orthopaedic Surgery
  • 11 Downloads

Abstract

Background

The increasing demand for arthroplasty has resulted in an inevitable rise in the number of periprosthetic fractures around implants. Survival factors looking into patient’s comorbidities and how they influence outcome are rare. This study aims to identify correlations between survival post-injury and pre-existing comorbidities.

Methods

A total of 144 patients underwent operative treatment for either a hip or a knee periprosthetic fracture from January 2008 to August 2017 at our Major Trauma Hospital. The mean age at injury was 80.9 years old (SD 9.9). Each patient had a case-based analysis to ascertain injury characteristics, operative parameters and comorbidities.

Results

The mean survival was 12.7 months (95% CI 8.4–17.1). Survival analysis showed a correlation between age more than 75 years old (p = 0.001), ASA grade of 3 or higher (p = 0.009 Breslow’s test), history of CVA or TIA (p = 0.038 Breslow’s test), dementia (p = 0.002 log rank test), depression (p = 0.013 log rank test) and gender (p = 0.041, Breslow’s test) and survival post-periprosthetic fracture. Survival within the first year following injury was found to be affected by the presence of osteoporosis (p = 0.020) and dementia (p = 0.002).

Conclusion

Periprosthetic fractures are associated with a high mortality risk (34.7%). Operative risks can be minimised with careful optimisation and surgical planning. ASA, age and comorbidities (dementia, CVA or TIA, osteoporosis) have a significant correlation with survival post-injury. Hence, careful patient selection for operative treatment is advised.

Keywords

Periprosthetic fracture Mortality Comorbidities 

Notes

Funding

No funding was received for the production of this paper or monetary incentives for the people involved in the management of these patients.

Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organisation or entity with financial interest or non-financial interest in the subject matter discussed in this manuscript.

Ethical approval and consent

No animals or human subjects were used for this project. This was a retrospective study evaluating comorbidities and their outcomes post-periprosthetic fractures around hip and knee arthroplasties. Hence, IRB approval was not sought or required. No consent was sought or required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Trauma and Orthopaedics, University Hospitals of North Midlands NHS TrustRoyal Stoke HospitalStoke-on-TrentUK
  2. 2.BirminghamUK

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