Analysis of mortality after surgical treatment of periprosthetic distal femur fractures

• Published in: Revista española de cirugía ortopédica y traumatología 2020-03, Vol.64 (2), p.92-98
• Main Authors: García Guirao, A.J., Andrés Cano, P., Moreno Domínguez, R., Giráldez Sánchez, M., Cano Luís, P.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Female; Femoral Fractures - mortality; Femoral Fractures - surgery; Follow-Up Studies; Fracturas periprotésicas; Fracture Fixation - methods; Fracture Fixation - mortality; Humans; Kaplan-Meier Estimate; Knee; Male; Middle Aged; Mortalidad; Mortality; Periprosthetic fractures; Periprosthetic Fractures - mortality; Periprosthetic Fractures - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Rodilla; Supervivencia; Survival
• ISSN: 1988-8856; 1988-8856
• DOI: 10.1016/j.recote.2020.02.006

The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007 and 2015, with a minimum follow-up of 12 months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. We reviewed a total of 97 patients with an average age of 75 years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1 days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75 years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study. Está aumentando la incidencia de las fracturas periprotésicas de rodilla debido al incremento en el número de artroplastias totales de rodilla realizadas, junto al envejecimiento poblacional. Encontramos escasos estudios que analicen en nuestro medio la mortalidad a largo plazo tras la intervención quirúrgica. Nuestro objetivo fue evaluar la mortalidad y supervivencia tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal en nuestro medio. Realizamos un estudio observacional retrospectivo de una serie consecutiva de 97 pacientes interveni