Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS)

• Published in: Injury 2024-10, Vol.55 (10), p.111715, Article 111715
• Main Authors: Andrés-Peiró, José Vicente, Aguado, Héctor J, González-Morgado, Diego, Minguell-Monyart, Joan, Joshi-Jubert, Nayana, Tomàs-Hernández, Jordi, Selga-Marsà, Jordi, García-Sánchez, Yaiza, Noriega-González, David C, Pereda-Manso, Adela, Cervera-Díaz, M Carmen, Balvis-Balvis, Patricia, Rodríguez-Arenas, Mónica, Moreta, Jesús, Olías-López, Beatriz, Blas-Dobón, José Antonio, Freile-Pazmiño, Patricio, Castillón, Pablo, Cabria-Fernández, Julián, Valle-Cruz, José, García-Coiradas, Javier, Bonome-Roel, César, Cano-Leira, María de los Ángeles, Benjumea-Carrasco, Antonio, Fernández-Juan, Alexis, Saura-Sánchez, Eladio, Sánchez-Gómez, Plácido, Ricón-Recarey, Francisco Javier, García-García, Elena María, Medrano-Morte, Isabel, Cuadrado-Abajo, Francisco, Pérez-Núñez, María I, García-González, Sara, García-Navas-García, Francisco Manuel, García-Paredero, Ester, Guijarro-Valtueña, Ainhoa, Navas-Pernía, Inés, Videla-Cés, Miquel, Querolt-Coll, Jordi, Triana-López de Santamaría, Guillermo, Serra-Porta, Teresa, Carrasco-Becerra, M Carmen, Pena-Paz, Silvia, Fernández-Dorado, Fátima, Martínez-Menduiña, Amaia, Galián-Muñoz, Elena, Hernández, José M, Renau-Cerrillo, Marina, Campuzano-Bitterling, Borja, Carreras-Castañer, Anna, Vives-Barquiel, Marian, Camacho-Carrasco, Pilar, Jornet-Gibert, Montsant, Muñoz-Vicente, Adrián, Gámez-Asunción, Carla, Benito-Santamaría, Jennifer, Cuenca-Copete, Alejandro, Alonso-Viana, Laura, Mingo-Robinet, Juan, Briso-Montiano, Ricardo, Barbería-Biurrun, Amaya, Ojeda-Thies, Cristina, Ajuria-Fernández, Eliam, Díaz-Suárez, Rebeca, Gasset-Teixidor, Alfons, Gosálbez, Javier, Pérez-Hevia, Imanol, Riera-Álvarez, Luís, Roche-Albero, Adrián, Macho-Mier, María, Criado-Albillos, Guillermo, Cabello-Benavides, Hugo Gabriel, Cunchillos-Pascual, Jorge, Saló-Cuenca, José Carlos, Espona-Roselló, Jordi, Salamanca-Ontiveros, César, García-Portabella, Pablo, Martínez-Íñiguez Blasco, Jorge, Sevilla-Ortega, Paloma, Cano-Porras, Juan Ramón, Martínez-Díaz, Santos, Carabelli, Guido Sebastián, Slullitel, Pablo, Astore, Ignacio, Hernández-Pascual, Carlos, Córdova-Peralta, Julio C, Sánchez-Hernández, Natalia, García-García, Guillermo, Rodríguez-Gangoso, Alfredo, Pérez-Sánchez, José María, Piñeiro-Borrero, Ana, De Caso-Rodríguez, Julio, Benito-Mateo, Miguel, Murillo-Vizuete, Antonio D, Herrán-Núnez, Gaspar De La, Nunes-Ugarte, Nahikari, Pérez-Salazar, Nicolás Elizalde, García-Fuentes, Xoan D, de Cortázar-Antolín, Unai García, Sánchez, Daniel Escobar
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Female; femur fracture; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Hip Fractures - surgery; Humans; internal fixation; Length of Stay - statistics & numerical data; Male; Middle Aged; multivariable analysis; outcomes; Periprosthetic Fractures - surgery; periprosthetic hip fracture; Postoperative Complications - epidemiology; Prospective Studies; Registries; Risk Factors; Spain - epidemiology; Treatment Outcome
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111715

To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.