Impact of periprosthetic femoral fractures on frailty, mobility and outcomes in hip arthroplasty

TL;DR

This study examines how periprosthetic femoral fractures impact mobility, frailty, and mortality in elderly patients undergoing hip arthroplasty.

Contribution

The study provides new insights into the long-term mobility and frailty changes following periprosthetic femoral fractures.

Findings

Patients experienced significant decreases in mobility scores after fractures.

Frailty increased significantly in patients at one-year follow-up.

Higher comorbidity scores correlated with increased one-year mortality.

Abstract

The demand for total hip arthroplasty and hemiarthroplasty is rising, increasing the incidence of periprosthetic femoral fractures. This study aimed to assess clinical outcomes, including mortality, length of stay, and the impact of periprosthetic femoral fractures on mobility and frailty at one-year follow-up.

A retrospective analysis of prospectively collected data was conducted looking at periprosthetic femoral fractures at a tertiary referral center from 2018 to 2024. The data collected included comorbidities, fracture classification, treatment method, length of stay, and discharge destination. The mortality rates at 30 days and one year were calculated. Mobility and frailty were assessed via the New Mobility Score and Clinical Frailty Scale before fracture and at one year. Statistical analysis included chi-square and Wilcoxon signed rank tests.

A total of n = 79 patients met the inclusion criteria (mean age 79.6 ± 9.5 years). There was a preponderance of females (35:44, M: F, p = 0.311). Vancouver B2 was the most common fracture pattern (n = 38). Surgical fixation was performed in n = 58 patients. Mortality rate at 30-day and one-year were 7.5% (n = 6) and 16.4% (n = 12) respectively. The mean Charlson Comorbidity Index was 4.39, with a score greater than 5 associated with higher one-year mortality (p = 0.031). Nursing home residency increased by 16%. The median New Mobility Score decreased from 7 to 5 (p < 0.001). The median Clinical Frailty Scale score increased from 4 to 5 (p < 0.001).

Periprosthetic femoral fractures affect elderly, comorbid patients and are associated with high mortality. We observed measurable and significant decreases in mobility and frailty. Prompt treatment and early mobilization should be prioritized to improve outcomes.

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