Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties
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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.
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.
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).
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.
KeywordsPeriprosthetic fracture Mortality Comorbidities
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.