Mitchell, Alex Steven orcid.org/0000-0001-9311-2092, Hewitt, Catherine Elizabeth orcid.org/0000-0002-0415-3536, McDaid, Catriona Maria orcid.org/0000-0002-3751-7260 et al. (2 more authors) (2022) Management and outcomes of femoral periprosthetic fractures at the hip:data from the characteristics, outcomes and management of periprosthetic fracture service evaluation (COMPOSE) cohort study. The Bone and Joint journal. pp. 997-1008. ISSN 2049-4394
Abstract
AIMS: The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. METHODS: This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression. RESULTS: In all, 417 fractures (77%) were managed operatively and 122 (23%) conservatively. The median time to surgery was four days (interquartile range (IQR) 2 to 7). Of those undergoing surgery, 246 (59%) underwent revision and/or fixation and 169 (41%) fixation alone. The surgical strategy used differed by Unified Classification System for PPF type, with the highest rate of revision in B2/B3 fractures (both 77%, 176/228 and 24/31, respectively) and the highest rate of fixation alone in B1- (55/78; 71%) and C-type (49/65; 75%) fractures. Cemented stem fixation (odds ratio (OR) 2.66 (95% confidence interval (CI) 1.42 to 4.99); p = 0.002) and B2/B3 fracture type (OR 7.56 (95% CI 4.14 to 13.78); p < 0.001) were predictors of operative management. The median length of stay was 15 days (IQR 9 to 23), 12-month reoperation rate was 5.6% (n = 30), and 30-day readmission rate was 8.4% (n = 45). The 30-day and 12-month mortality rates were 5.2% (n = 28) and 21.0% (n = 113). Nonoperative treatment, older age, male sex, admission from residential or nursing care, and sustaining the PPF around a revision prosthesis were significant predictors of an increased 12-month mortality. CONCLUSION: Femoral hip PPFs have mortality, reoperation, and readmission rates comparable with hip fracture patients. However, they have a longer wait for surgery, and surgical treatment is more complex. There is a need to create a national framework for data collection for this heterogeneous group of patients in order to understand the outcomes of different approaches to treatment. Cite this article: Bone Joint J 2022;104-B(8):997-1008 .
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The British Editorial Society of Bone & Joint Surgery. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details |
Keywords: | Adult,Arthroplasty, Replacement, Hip/adverse effects,Cohort Studies,Femoral Fractures/surgery,Fracture Fixation, Internal,Hip Prosthesis/adverse effects,Humans,Male,Periprosthetic Fractures/surgery,Reoperation,Retrospective Studies |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Depositing User: | Pure (York) |
Date Deposited: | 17 Aug 2022 09:10 |
Last Modified: | 24 Mar 2025 00:09 |
Published Version: | https://doi.org/10.1302/0301-620X.104B8.BJJ-2021-1... |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1302/0301-620X.104B8.BJJ-2021-1682.R1 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:190096 |
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Filename: COMPOSE_Paper_2_Management_and_outcomes_Revision_FINAL_1_.docx
Description: Management and Outcomes of Femoral Hip Periprosthetic Fractures: Data from the Characteristics, Outcomes and Management of PeriprOsthetic Fracture Service Evaluation (COMPOSE) cohort study