Title : Management of femoral periprosthetic fractures: An institutional experience at a district general hospital
Abstract:
Introduction: A total hip replacement is one of the most common procedures performed in trauma and orthopaedic surgery. Successful outcomes following arthroplasty surgery, coupled with the ageing population, has contributed to more hip replacements being performed by orthopaedic surgeons. An increase in the incidence of femoral periprosthetic fractures has been observed due to this, leading to an increase in the number of revision hip replacements being performed annually.
Aim: The primary aim of this study was to assess whether there is a higher mortality rate associated with delayed surgical intervention for femoral periprosthetic fractures. This study also assessed whether post-operative complications were associated with delayed surgical intervention.
Methods: The patients were reviewed retrospectively in this cohort study, which was carried out at a district general hospital in the United Kingdom. A retrospective review of the patients from 2018-2022 was carried out by reviewing the theatre records. The patients were split into two groups where the first group analysed the patient outcomes according to the type of surgical intervention. The second group analysed the outcomes according to the timing of surgical intervention being carried out within or after 36 hours of diagnosis.
Results: In total, 88 patients were included in this study where 49 patients had revision surgery and 39 had fixation. It was observed that there was no statistically significant difference in 30- day mortality and one year mortality when analysing the patients according to the type of surgical intervention. Likewise, there was no statistically significant difference in 30-day and one year mortality when comparing the patients according to the timing of surgical intervention of before or after 36 hours; the p values were >0.05 for these two groups. It was noted that there were more post-operative complications for the patients who had surgery within 36 hours of diagnosis and this was statistically significant with a p value of 0.014.
Conclusion and Recommendations: In conclusion, the results of this study are in keeping with the literature. There is no significant impact on 30-day and one year mortality with a delay in surgical intervention for femoral periprosthetic fractures, unlike native hip fractures. Although the effect of delayed surgical intervention on long term mortality remains uncertain, better outcomes are achieved through medical optimisation and careful planning.
