Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 4, pp 475–482 | Cite as

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

  • Georgios OrfanosEmail author
  • Justin Lim
  • Bishoy Youssef
Orthopaedic Surgery



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.


Periprosthetic 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.


  1. 1.
    Mardian S, Perka C, Schaser KD, Gruner J, Scheel F, Schwabe P (2017) Cardiac disease and advanced age increase the mortality risk following surgery for periprosthetic femoral fractures. Bone Joint J 99-B(7):921–926CrossRefGoogle Scholar
  2. 2.
    Fuchtmeier B, Galler M, Muller F (2015) Mid-term results of 121 periprosthetic femoral fractures: increased failure and mortality within but not after one postoperative year. J Arthroplasty 30(4):669–674CrossRefGoogle Scholar
  3. 3.
    Lindahl H, Garellick G, Regner H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88(6):1215–1222CrossRefGoogle Scholar
  4. 4.
    Korbel M, Sponer P, Kucera T, Prochazka E, Procek T (2013) Results of treatment of periprosthetic femoral fractures after total hip arthroplasty. Acta Medica (Hradec Kralove) 56(2):67–72CrossRefGoogle Scholar
  5. 5.
    Zuurmond RG, van Wijhe W, van Raay JJ, Bulstra SK (2010) High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases. Injury 41(6):629–633CrossRefGoogle Scholar
  6. 6.
    Young SW, Walker CG, Pitto RP (2008) Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 79(4):483–488CrossRefGoogle Scholar
  7. 7.
    Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304Google Scholar
  8. 8.
    Su ET, DeWal H, Di Cesare PE (2004) Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg 12(1):12–20CrossRefGoogle Scholar
  9. 9.
    Felix NA, Stuart MJ, Hanssen AD (1997) Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 345:113–124CrossRefGoogle Scholar
  10. 10.
    Duncan CP, Haddad FS (2014) The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 96-B(6):713–716CrossRefGoogle Scholar
  11. 11.
    Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246CrossRefGoogle Scholar
  12. 12.
    Fink B (2014) Revision arthroplasty in periprosthetic fractures of the proximal femur. Oper Orthop Traumatol 26(5):455–468CrossRefGoogle Scholar
  13. 13.
    Moreta J, Aguirre U, de Ugarte OS, Jauregui I, Mozos JL (2015) Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury 46(2):292–298CrossRefGoogle Scholar
  14. 14.
    Spina M, Rocca G, Canella A, Scalvi A (2014) Causes of failure in periprosthetic fractures of the hip at 1- to 14-year follow-up. Injury 45(Suppl 6):S85–S92CrossRefGoogle Scholar
  15. 15.
    Young SW, Pandit S, Munro JT, Pitto RP (2007) Periprosthetic femoral fractures after total hip arthroplasty. ANZ J Surg 77(6):424–428CrossRefGoogle Scholar
  16. 16.
    Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284CrossRefGoogle Scholar
  17. 17.
    Griffiths EJ, Cash DJ, Kalra S, Hopgood PJ (2013) Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures. Injury 44(12):1949–1952CrossRefGoogle Scholar
  18. 18.
    Singh SP, Bhalodiya HP (2013) Outcome and incidence of periprosthetic supracondylar femoral fractures in TKA. Indian J Orthop 47(6):591–597CrossRefGoogle Scholar
  19. 19.
    Sathiyakumar V, Molina CS, Thakore RV, Obremskey WT, Sethi MK (2015) ASA score as a predictor of 30-day perioperative readmission in patients with orthopaedic trauma injuries: an NSQIP analysis. J Orthop Trauma 29(3):e127–e132CrossRefGoogle Scholar
  20. 20.
    Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H (2007) Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am 89(12):2658–2662CrossRefGoogle Scholar
  21. 21.
    Park KJ, Menendez ME, Barnes CL (2017) Perioperative periprosthetic fractures associated with primary total hip arthroplasty. J Arthroplasty 32(3):992–995CrossRefGoogle Scholar

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

Personalised recommendations