Title : Outcomes and management of Periprosthetic Femoral Fractures (PPFs) following introduction of British hip society guidelines
Abstract:
Aims: This study intends to define the outcomes of Periprosthetic Femoral Fractures (PPFs) by fracture type and management strategy since the introduction of British Hip Society guidelines.
Methods: This was a retrospective cohort series of adult patients admitted with PPFs to our Trust between 2022 -2025. Fractures were classified according to the Vancouver classification. Data was gathered from patient records and the National Hip Fracture Dataset. Patient characteristics, management decision, time to theatre and outcomes were recorded.
Results: A total of 288 PPFs were treated over the study period. 221 were treated operatively: 155 fixation, 66 revision; 67 were managed non-operatively. Median length of time to surgery was 64hrs (IQR 33-115hrs), revision was associated with longer delays. 53.5% of patients underwent surgery within 72hrs as per BHS guidelines. Early surgery was associated with a lower mortality at 30 days (RR 0.63, 95% CI 0.18–2.17) and one year (RR 0.66, 95% CI 0.35–1.24). Post-operative full weightbearing varied by operative decision: 50% (76/152) for fixation 62% (41/66) revision. 70% (48/69) of cases treated non-operatively were full weightbearing. Non-weightbearing trended towards longer inpatient stays and higher mortality. 70% of patients were discharged to their original level of independence. Temporal trends in time to theatre and restricted weightbearing are unchanged in the years since BHS guideline publication.
Conclusion: Periprosthetic femoral fractures experience large variations in time to theatre and post-operative weightbearing. Two thirds of patients treated currently meet BHS guidelines; this has not improved over time. Non-weightbearing is associated with increased mortality.
