# Periprosthetic Femur Fractures Managed by Revision Arthroplasty

## TL;DR

This study examines the outcomes of revision arthroplasty for periprosthetic femur fractures in elderly patients, highlighting the challenges and risks involved.

## Contribution

The paper provides new insights into surgical outcomes and complications of revision arthroplasty for periprosthetic femur fractures in a high-risk elderly population.

## Key findings

- Modular fluted stems were the most commonly used surgical strategy for PFFs.
- Twelve patients died during follow-up, with seven deaths occurring after one year.
- Complications included infection, dislocation, and leg length discrepancy, but most were managed without further revision.

## Abstract

Background

Periprosthetic femoral fractures (PFFs) are a growing indication for revision total hip arthroplasty (THA), particularly in elderly patients with complex comorbidities. Surgical management is challenging, with significant morbidity and mortality. This study evaluates outcomes following revision arthroplasty for PFFs at a tertiary trauma centre in the United Kingdom .

Methods

A retrospective review was conducted of 24 patients who underwent revision arthroplasty for PFFs between February 2021 and January 2022. Data collected included patient demographics, fracture classification, implant history, surgical details, and complications. Follow-up data were extracted from electronic health records up to February 2025. The primary outcome was the need for further revision; secondary outcomes included mortality and postoperative complications.

Results

The cohort had a mean age of 78.3 years (IQR: 16), with most injuries resulting from low-energy trauma. Vancouver B-type fractures were the most common, and three patients sustained interprosthetic fractures. Surgical strategies included modular fluted stems (n=13), femoral replacement prostheses (n=7), and cemented stems (n=4). Complications included one infection managed with suppressive antibiotics, two recurrent dislocations, and two cases of leg length discrepancy. One patient required further revision for instability. Twelve patients died during follow-up: two within 30 days, three within one year, and seven after one year. Thirteen patients were followed remotely due to frailty or relocation.

Conclusion

Revision arthroplasty for PFFs involves technically demanding procedures with significant risks. Despite the complexity, outcomes were in line with published data. Multidisciplinary care, timely surgical intervention, and individualised implant selection remain critical to optimise outcomes in this high-risk population.