Periprosthetic femoral fractures: Ten-year clinical experience using a fracture-specific fixation system: A retrospective study.

Abstract

Background: Incidence of periprosthetic femoral fractures (PFFs) is increasing with rising use of hip and knee arthroplasty in the elderly population. These injuries require complex management and are associated with high morbidity and mortality.

Aim: To evaluate outcomes and complications of PFFs in 111 patients treated with Zimmer Biomet Non-Contact Bridging (NCB) plating over a 10-year period.

Methods: Retrospective analysis of 111 patients treated with NCB plating from 2012 to 2022 at a single UK centre was conducted. Fractures were classified by the Unified Classification System (UCS). Data collection consisted of patient demographics, the type of fracture, and follow-up outcomes; primary outcomes were fracture union, implant failure, reoperation rates and mortality at 30 days and 1 year. Secondary outcomes included functional mobility and length of admission. Continuous and categorical variables were compared using Mann-Whitney U and Fisher's exact tests; predictors of non-union and mortality were examined using Firth's penalised logistic regression.

Results: Median patient age was 81 years (age range was 43-100 years). Fractures involved 68 total hip replacements, 42 total knee replacements, 17 retained intramedullary nails, and one hip hemiarthroplasty. UCS types were A (n = 1), B1 (n = 49), B2 (n = 10), C (n = 34), and D (n = 14). Non-union occurred in 13% of assessable patients (n = 12) with seven patients requiring revision surgery. Mortality was 4.5% at 30 days and 14.4% at one year. At one year follow-up, 68% of patients had maintained or improved their mobility status compared to prior to their injury. Patient age, post operative weight bearing status, working length, ASA grade and UCS classification type bore no statistical significance when used as predictors for non-union, but cable use did.

Conclusion: We continue to believe that the NCB plate remains an effective management strategy for PFFs and that some outcomes are more specifically related to the nature of the injury.