Title : Weight Bearing (WB) status after Peri-Prosthetic Proximal Femur Fracture (PPPFFs) ORIF or revision arthroplasty: A clinical audit
Abstract:
Background: Peri-prosthetic proximal femur fractures (PPFFs) are becoming increasingly common due to the rising number of Total Hip Arthroplasties (THAs) in ageing populations. These complex fractures often require either Open Reduction and Internal Fixation (ORIF) or revision arthroplasty. Post-operative Weight Bearing (WB) status plays a critical role in recovery, yet there is considerable variability in clinical practice.
Objectives: This audit aimed to evaluate the documentation and implementation of post-operative weight bearing protocols following ORIF or revision arthroplasty for PPFFs. It assessed adherence to best practice guidelines, reasons for deviations, and rates of fixation failure.
Methods: A retrospective audit was conducted at a UK District General Hospital between January 2023 and June 2024. Data was collected from the Hip Fracture Registry. Inclusion criteria were patients with closed PPFFs around THA or hemiarthroplasty; exclusions included fractures involving intra-medullary devices or knee prostheses. Patients were classified using the Vancouver classification (types A-C). Data points included fracture type, treatment modality, post-operative WB status, rationale for WB decision, and fixation outcomes.
Results: Thirty-eight patients met the inclusion criteria: 4 (10.5%) had type A fractures, 28 (73.7%) type B, and 6 (15.8%) type C. 28 (73.7%) patients underwent surgical intervention (19 ORIF, 9 revision arthroplasty), while 10 (26.3%) were managed conservatively. Of the surgical group, 22 (78.6%) were mobilised as FWB, 4 (14.3%) were limited weight bearing (LWB), and 2 (7.1%) were non-weight bearing (NWB). LWB was most often attributed to intra-operative identification of poor bone stock; NWB was associated with medial calcar instability or metastatic involvement. Only 1 (3%) patient experienced fixation failure, with conservative management adopted due to co-morbidities. A notable finding was the lack of detailed documentation for WB restrictions in LWB and NWB groups, which posed challenges for post-operative rehabilitation.
Conclusions: This audit demonstrates that while the majority of PPFF patients were managed in accordance with national guidance promoting early FWB, a significant proportion received restricted WB without adequate justification. The low rate of fixation failure supports the feasibility of immediate FWB in appropriately selected patients. However, the absence of clear functional instructions in many cases highlights a need for improved communication and standardised documentation. Further multi-centre studies are required to establish robust, evidence-based post-operative protocols for this growing patient population.
