Clinical outcome of periprosthetic femoral fractures: the influence of fracture pattern and patient specific risk factors

Özman DD; Bolierakis E; Weber CD; Groven RVM; Balmayor ER; Hildebrand F; Horst K

Abstract

Purpose The incidence of periprosthetic femoral fractures (PFF) has risen, but literature on patient characteristics, risk factors, and outcomes remains limited. This study investigates radiological and clinical outcomes in relation to patient demographics and fracture patterns to identify possible risk factors and previously undetected associations. Methods This retrospective study included patients with hip arthroplasty who sustained PFF between 2007 and 2021. Data on demographics, medical history, fracture pattern (Vancouver Classification), injury mechanism, radiological findings (e.g., osteoporosis via the Singh index), bone healing (RUSH score), bone resorption, non-union, surgical treatment, and clinical outcomes were extracted. Statistical correlations were calculated using IBM SPSS Statistics Version 28.0.0.0. (IBM Corp., Armonk, NY, USA). Results 110 patients were included, 70% female, with a mean age of 78 ± 11 years. The most common potential risk factors for PFF were uncemented stem components (69%), bone resorption (68%), female sex (70%), and osteoporosis (21%). Hospital stay was longest for B2 and B3 fractures, with B3 fractures requiring the longest intensive care unit time (mean of 3 ± 4 days, p = 0.041). Complications included wound infections (12%), urinary tract infections (20%) and postoperative anemia (51%). Osteoporosis was correlated with female sex and a higher risk of non-union, but did not influence bone healing. Conclusions PFF present clinical challenges, with fracture type and complications influencing hospital stay and postoperative mobility. Type B fractures are associated with longer treatment times and higher complication rates. Osteoporosis does not appear to significantly affect bone healing in this cohort.