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Multicenter Study
. 2024 Feb 1;106-B(2):158-165.
doi: 10.1302/0301-620X.106B2.BJJ-2023-0700.R1.

The characteristics and predictors of mortality in periprosthetic fractures around the knee

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

The characteristics and predictors of mortality in periprosthetic fractures around the knee

Ahmed A H H Nasser et al. Bone Joint J. .

Abstract

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality.

Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.

Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.

Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.

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Conflict of interest statement

A. A. H. H. Nasser and A. Mahmood report funding from Queen Elizabeth Hospital Birmingham Charity Trauma Research and Education Fund, related to this study.

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