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. 2023 Dec;54(12):111152.
doi: 10.1016/j.injury.2023.111152. Epub 2023 Oct 24.

Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study

Ahmed Abdul Hadi Harb Nasser  1 , Rohan Prakash  2 , Charles Handford  2 , Khabab Osman  2 , Govind Singh Chauhan  2 , Rajpal Nandra  3 , Ansar Mahmood  4 , Varun Dewan  3 , Jerome Davidson  5 , Mohammed Al-Azzawi  5 , Christian Smith  5 , Mothana Gawad  5 , Ioannis Palaiologos  6 , Rory Cuthbert  6 , Warran Wignadasan  6 , Daniel Banks  7 , James Archer  7 , Abdulrahman Odeh  7 , Thomas Moores  8 , Muaaz Tahir  8 , Margaret Brooks  8 , Gurdeep Biring  9 , Stevan Jordan  9 , Zain Elahi  9 , Mohammed Shaath  9 , Manoj Veettil  10 , Chiranjit De  10 , Charles Handford  10 , Mohit Bansal  11 , Akshdeep Bawa  11 , Ahmed Mattar  11 , Varun Tandra  11 , Audrina Daadipour  11 , Ahmed Taha  11 , Shafat Gangoo  12 , Sriram Srinivasan  12 , Mandishona Tarisai  12 , Basil Budair  13 , Krishna Subbaraman  13 , Farrukh Khan  13 , Austin Gomindes  13 , Arjun Samuel  13 , Niel Kang  14 , Karan Kapur  14 , Elizabeth Mainwaring  14 , Hannah Bridgwater  14 , Andre Lo  14 , Usman Ahmed  15 , Tahir Khaleeq  15 , Ahmed El-Bakoury  16 , Ramy Rashed  16 , Hazem Hosny  16 , Rathan Yarlagadda  16 , Jonathan Keenan  16 , Ahmed Hamed  16 , Bryan Riemer  17 , Arham Qureshi  17 , Vatsal Gupta  17 , Matthew Waites  18 , Sabri Bleibleh  18 , David Westacott  18 , Jonathan Phillips  19 , Jamie East  19 , Daniel Huntley  19 , Saqib Masud  20 , Yusuf Mirza  20 , Sandeep Mishra  20 , David Dunlop  21 , Mohamed Khalefa  21 , Balakumar Balasubramanian  21 , Mahesh Thibbaiah  21 , Olivia Payton  21 , James Berstock  22 , Krisna Deano  22 , Khaled Sarraf  23 , Kartik Logishetty  23 , George Lee  23 , Hariharan Subbiah-Ponniah  23 , Nirav Shah  24 , Aakaash Venkatesan  24 , James Cheseldene-Culley  24 , Joseph Ayathamattam  24 , Samantha Tross  25 , Sukhwinder Randhawa  25 , Faisal Mohammed  25 , Ramla Ali  25 , Jonathan Bird  26 , Kursheed Khan  26 , Muhammad Adeel Akhtar  27 , Andrew Brunt  27 , Panagiotis Roupakiotis  27 , Padmanabhan Subramanian  28 , Nelson Bua  28 , Mounir Hakimi  29 , Samer Bitar  29 , Majed Al Najjar  29 , Ajay Radhakrishnan  29 , Charlie Gamble  29 , Andrew James  30 , Catherine Gilmore  30 , Dan Dawson  30 , Rajesh Sofat  31 , Mohamed Antar  31 , Aashish Raghu  31 , Sam Heaton  32 , Waleed Tawfeek  32 , Christerlyn Charles  32 , Henry Burnand  33 , Sean Duffy  33 , Luke Taylor  33 , Laura Magill  34 , Rita Perry  34 , Michala Pettitt  34 , Kelvin Okoth  34 , Thomas Pinkney  34
Affiliations

Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study

Ahmed Abdul Hadi Harb Nasser et al. Injury. 2023 Dec.

Abstract

Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.

Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality.

Results: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality.

Conclusion: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.

Keywords: Periprosthetic; arthroplasty; fracture; mortality.

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Conflict of interest statement

Declaration of Competing Interest A.M is the president of the British Trauma Society. The author(s) received no financial or material support for the research, authorship, and/or publication of this article.

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