Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

• Published in: Journal of orthopaedics and traumatology 2024-03, Vol.25 (1), p.13-13, Article 13
• Main Authors: Aguado, Héctor J., Castillón-Bernal, Pablo, Teixidor-Serra, Jordi, García-Sánchez, Yaiza, Muñoz-Vives, Josep M., Camacho-Carrasco, Pilar, Jornet-Gibert, Montsant, Ojeda-Thies, Cristina, García-Portabella, Pablo, Pereda-Manso, Adela, Mateos-Álvarez, Elvira, Manzano-Mozo, Javier, Carrillo-Gómez, Raquel, País-Ortega, Sergio, García-Virto, Virginia, Noriega-González, David, Álvarez-Ramos, Begoña Aránzazu, Ganso-Pérez, Abel, Cervera-Díaz, Carmen, Plata-García, María, Ortega-Briones, Alina, Berrocal-Cuadrado, Juan, Criado del Rey-Machimbarrena, Diego, Salvador, Jordi, Rey, Laura, Tomás-Hernández, Jordi, Selga-Marsà, Jordi, Andrés-Peiró, José Vicente, Querolt-Coll, Jordi, Triana, Guillermo, Vives-Barquiel, Marian, Renau-Cerrillo, Marina, Campuzano-Bitterling, Borja, Hernández, José M, Ostilla, Ricardo, Carreras-Castañer, Anna, Torner, Pere, Díaz-Suárez, Rebeca, Fernández, Eliam Ajuria, Olaya-González, Carlos, Fernández-Villán, María, García de Cortázar, Unai, Arrieta, Mirentxu, Escobar, Daniel, Castrillo, Estíbaliz, Balvis, Patricia, Rodríguez-Arenas, Mónica, García-Pérez, Ángela, Moreta, Jesús, Bidea, Iñigo, Jiménez-Urrutia, Xabier, Olías-López, Beatriz, Boluda-Mengod, Juan, González-Martín, David, Bárcena-Goitiandia, Leopoldo, López-Dorado, Daniel, Borrás-Cebrián, Juan Carlos, García-Aguilera, David, Freile-Pazmiño, Patricio Andrés, Suárez-Suárez, Miguel Ángel, Lanuza-Lagunilla, Lucía, García-Arias, Antonio, Sánchez-Saz, Jaime, García-Coiradas, Javier, Valle-Cruz, José, Mora-Fernández, Jesús, Cano-Leira, María Ángeles, Rieiro, Guillermo, Benjumea-Carrasco, Antonio, Priego-Sánchez, Rodrigo Jesús, Sánchez-Pérez, Coral, Guadilla-Arsuaga, Jorge, Fernández-Juan, Alexis, Sánchez, Plácido, Ricón, Javier, Fuentes-Díaz, Alfonso, García-García, Elena M., Cuadrado-Abajo, Francisco, García-Portal, Gonzalo, del PozoManrique, Pedro, Castillo del Pozo, Virginia, Garcia-Navas, Francisco Manuel, García-Paredero, Ester, Beteta-Robles, Teresa, Guijarro-Valtueña, Ainhoa, Gutiérrez-Baiget, Gonzalo, Alonso-García, Noelia, Navas-Pernía, Inés, Ariza-Herrera, Diana, Vilanova, Joan, Videla-Cés, Miquel, Serra-Porta, Teresa, Vázquez-García, César, Carrasco-Becerra, Carmen, Pena-Paz, Silvia, Otero-Naveiro, Víctor, Fernández-Billón-Castrillo, Inés, Martínez-Menduiña, Amaia, Hernández-Galera, Carolina, Fernández-Dorado, Fátima
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Ankle; Arthroplasty; Biomedical materials; Cognitive ability; Comorbidity; Conservative Orthopedics; Constrictions; Disease management; Elbow; Elbow (anatomy); Epidemiology; Femoral components; Femur; Fracture fixation; Fractures; Frailty; Geriatric co-management; Hip; Hospitals; Humans; Joint surgery; Knee; Medicine; Medicine & Public Health; Morbidity; Mortality; NCT; NCT04663893; Observational studies; Original Article; Orthopedics; Outcome; Patients; Periprosthetic fracture; Periprosthetic Fractures - epidemiology; Periprosthetic Fractures - etiology; Periprosthetic Fractures - surgery; Prospective Studies; Prostheses; Regression models; Replacement; Revisions; Rheumatology; Spain - epidemiology; Sports Medicine; Statistical analysis; Surgical Orthopedics; Survival analysis; Traumatic Surgery; Weight
• ISSN: 1590-9999; 1590-9921; 1590-9999
• DOI: 10.1186/s10195-024-00746-6

Background The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. Methods PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. Results The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77–89), frail [median clinical frailty scale (CFS) 5, IQR 3–6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4–7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9–153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. Conclusions Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and m