Post-operative periprosthetic femoral fractures in England: patient profiles and short-term outcomes

Background and objective

Post-operative periprosthetic femoral fractures (POPFF) present a growing challenge for healthcare services, but there are limited national data on patient profiles, short-term outcomes, and post-discharge follow-up. We aimed to fill these gaps.

Methods

Using Hospital Episode Statistics (HES), we identified POPFF discharges from hospitals in England for patients aged 18 and above between April 2016 and December 2022. We flagged prior admissions for hip fracture and elective hip or knee replacement surgery (primary, revision or re-revision) between April 2000 and the day of the POPFF admission date. We extracted information on patient factors, treatment modes for POPFF (nonoperative, fixation, revision), and outcomes (in-hospital mortality, length of stay, unplanned readmission). We used outpatient data to summarise post-hospitalisation follow-up.

Results

Of 39,035 cases, 65.9% were female; the median age was 82 years. HES data identified that 34.0% had previously undergone elective hip replacement, 26.2% elective knee replacement, and 22.8% surgery for hip fracture. Those with a prior hip fracture were more likely to have delirium during the index POPFF admission, and, compared with those with a prior elective hip or knee replacement, they faced higher in-hospital mortality (5.1% vs 3.2% and 3.6%, respectively), rates of readmission (15.4% vs 13.1% and 12.8%, respectively), and hip re-fracture after POPFF (2.9% vs 1.2% and 1.6%, respectively). Their median length of stay was longer (16 vs 14 days, p<0.001). The most common reason for hospital readmission following POPFF was another fracture (11.3% of all readmissions). Overall, 74% of patients were discharged from outpatient follow-up within 12 months.

Conclusion

This is the first national description of the burden of adverse outcomes for people with POPFF in England, of whom a large proportion require ongoing specialist support. Fewer POPFF cases follow prior hip fracture surgery than elective joint replacement, but these patients face higher risks of worse outcomes. With an expected increasing incidence of POPFF, this may have considerable health service implications.