Periprosthetic Fractures around Total Hip Replacement-Is There a Rush to Fix?

Abstract

Background: Periprosthetic fractures now account for 14.1% of all hip revisions. Surgery is often highly specialised and can involve the revision of implants, fixation of fractures, or a combination of both. Delays to surgery are frequent as specialist equipment and surgeons are often required. UK guidelines are currently moving in favour of early surgery in a similar way to the neck of femur fractures, despite a lack of evidential consensus.

Methods: A retrospective review of all patients who underwent surgery for periprosthetic fractures around a total hip replacement (THR) at a single unit between 2012 and 2019 was performed. Risk factors for complications, length of stay (LOS), and time to surgery data were collected and analysed using regression analysis.

Results: A total of 88 patients met the inclusion criteria: 63 (72%) were treated with open reduction internal fixation (ORIF) and 25 (28%) underwent revision THR. Baseline characteristics were similar in both the ORIF and revision groups. Revision surgery was more likely to be delayed than ORIF owing to the need for specialist equipment and personnel (median 143 h vs. 120 h, p = 0.04). Median LOS was 17 days if operated within 72 h and 27 days if delayed beyond this (p < 0.0001), but there was no increase in 90-day mortality (p = 0.66), HDU admission (p = 0.33), or perioperative complications (p = 0.27) with delay beyond 72 h.

Conclusion: Periprosthetic fractures are complex and require a highly specialised approach. Delaying surgery does not result in increased mortality or complications but does increase length of stay. Further multicentre research into this area is required.

Keywords: early surgery; fracture; hip; periprosthetic; revision.

Figure 1

Patient selection and exclusion criteria. The flow of patients included in the study is shown. (THR = Total Hip Replacement, ORIF = Open Reduction Internal Fixation).