Identifying risk factors for one-year mortality after surgical treatment of periprosthetic femoral fractures around hip arthroplasty

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-08 DOI:10.1016/j.jcot.2025.103012

Maud A.M. Vesseur , Eva H.M. van Beurden , Lee H. Bouwman , Martijn G.M. Schotanus , Raoul van Vugt , Bert Boonen

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引用次数: 0

Abstract

Background

The increasing number of hip arthroplasties (HA) worldwide, including hemi- and total hip arthroplasties, has led to a rise in periprosthetic femoral fractures (PPFF). These fractures are technically complex, linked to high morbidity and mortality, and impose a burden on healthcare systems. However, clinical guidelines for managing PPFF are lacking, and data on factors affecting postoperative outcomes remain limited. This study aimed to identify risk factors for one-year mortality in surgically treated PPFF patients.

Methods

A retrospective single-center cohort study was conducted on patients with surgically treated PPFF. Data on patient-, implant-, fracture-, surgical- and perioperative characteristics were collected. Univariate and multivariable logistic regression analyses were used to identify independent predictors of one-year mortality.

Results

Among 157 patients (median age was 83 years, 59.2 % ASA III), the one-year overall mortality rate was 16.6 %. Multivariable analyses suggested that residency in a nursing home [OR 4.1 (95 %CI 1.20–14.25) p = 0.025], use of a walking aid [OR 3.6 (95 %CI 1.07–12.36) p = 0.039], initial uncemented stem fixation [OR 4.08 (95 %CI 1.25–13.35) p = 0.020], preoperative urinary bladder catheter (UBC) [OR 4.5 (95 %CI 1.33–15.25) p = 0.016] and lower Body Mass Index (BMI) (Kg/m²) [OR 0.87 (95 %CI 0.75–1.00) p = 0.049) were independently associated with one-year mortality.

Conclusion

PPFF patients are frail and highly comorbid. Risk factors such as low BMI, nursing home residency, walking aid use, uncemented stem fixation, and preoperative UBC highlight the need for targeted strategies to improve outcomes.

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确定人工髋关节周围股骨骨折手术治疗后一年死亡率的危险因素

背景全球髋关节置换术（HA）（包括半髋关节置换术和全髋关节置换术）的数量不断增加，导致股骨假体周围骨折（PPFF）的发病率上升。这些骨折技术复杂，发病率和死亡率高，给医疗系统带来了沉重负担。然而，目前尚缺乏管理股骨假体周围骨折的临床指南，有关影响术后结果的因素的数据也仍然有限。本研究旨在确定经手术治疗的PPFF患者一年内死亡率的风险因素。方法对经手术治疗的PPFF患者进行了一项回顾性单中心队列研究。研究收集了患者、植入物、骨折、手术和围手术期特征的数据。结果在157名患者（中位年龄为83岁，59.2%为ASA III级）中，一年总死亡率为16.6%。多变量分析表明，居住在疗养院[OR 4.1 (95 %CI 1.20-14.25) p = 0.025]、使用助行器[OR 3.6 (95 %CI 1.07-12.36) p = 0.039]、初始非骨水泥柄固定[OR 4.08 (95 %CI 1.25-13.35) p = 0.020]、术前膀胱导尿管（UBC）[OR 4.5 (95 %CI 1.33-15.25) p = 0.016]和较低体重指数（BMI）（Kg/m2）[OR 0.87 (95 %CI 0.75-1.00) p = 0.049)与一年死亡率独立相关。低体重指数、居住在养老院、使用助行器、非骨水泥柄固定和术前UBC等风险因素突出表明，需要采取有针对性的策略来改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.