Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec;5(4):147-53.
doi: 10.1177/2151458514542281.

Mortality and Financial Burden of Periprosthetic Fractures of the Femur

Edward Shields  1 , Caleb Behrend  2 , Jeff Bair  3 , Peter Cram  4 , Stephen Kates  5
Affiliations

Mortality and Financial Burden of Periprosthetic Fractures of the Femur

Edward Shields et al. Geriatr Orthop Surg Rehabil. 2014 Dec.

Abstract

Objective: This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities.

Methods: Data were retrospectively analyzed from a prospective database at a university hospital setting. One-hundred and thirteen patients with a periprosthetic fracture of the proximal or distal femur were identified. Risk factors for 12-month mortality were analyzed, and financial data were compared between the various treatment modalities.

Results: In all, 14% of patients died (16 of 113) within 3 months and the 1-year mortality was 17.7% (20 of 113). Patients who died within 1 year had higher hospital charges (US$33 880 ± 25 051 vs US$22 886 ± 16 841; P = .01) and were older (87.6 ± 8.5 vs 81.5 ± 8.6; P = .004). Logistic regression analysis revealed age was the only significant predictor of 1-year mortality (P = .029, odds ratio 1.1). Analysis of financial data revealed 4 distinct groups (P < .05 between groups). Distal femoral revision arthroplasty (RA-DF) generated the highest hospital charges of US$91 035 ± 25 579 (n = 3). The second most highly charged group included proximal femoral fractures treated with revision arthroplasty (US$34 078 ± 17 832; n = 20) and hemi/total hip arthroplasty (THA; US$41 556 ± 23 651; n = 8). The third most charged group underwent open reduction internal fixation of the proximal (US$18 706 ± 6829; n = 35) and distal (US$22 381 ± 10 835; n = 35) femur. Nonoperative treatment generated the lowest charges (US$6426 ± 2899; n = 11). On average, the hospital lost money treating patients with RA-DF (US$-19 080 ± 2022 per patient) and hemi/THA (US$-6594 ± 9305 per patient), while all other treatment groups were profitable.

Conclusion: One-year mortality after periprosthetic femur fractures was 17.7%, is mostly influenced by age, and 80% of deaths occur within 3 months. Patients treated with primary/revision arthroplasty generate more hospital charges than internal fixation. The average patient treated with revision arthroplasty of the distal femur or hemi/THA for a periprosthetic femur fractures resulted in net financial losses for the hospital.

Keywords: geriatric fracture; hospital charges; mortality; periprosthetic femur fracture.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Treatment hospital charges statistically fell into 4 distinct groups (analysis of variance [ANOVA] P < .05). Revision arthroplasty of the distal femur (RA-DF; n = 3) generated the most charges (P < .05). The nonoperative group (n = 11) generated the least charges (P < .05). *The second most costly group included revision arthroplasty of the proximal femur (n = 20) and the hemi/total hip arthroplasty (THA; n = 8) groups (P < .05). #The third most costly group was ORIF of the distal (ORIF-DF; n = 35) and proximal femur (ORIF-PF; n = 35; P < .05). ORIF indicates open reduction internal fixation.
See this image and copyright information in PMC

Comment in

References

    1. Noor S, Pridham C, Fawcett T, et al. Finite element analysis modelling of proximal femoral fractures, including post-fixation periprosthetic fractures. Injury. 2013;44 (6):791–795. - PubMed
    1. Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011;93 (1):96–101. - PubMed
    1. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38 ( 6 ):651–654. - PubMed
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89 (4):780–785. - PubMed
    1. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30 ( 2 ):183–190. - PubMed