Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

Abstract

Introduction: Periprosthetic femur fractures (PPFX) are complications of both total hip and knee arthroplasty and may be treated with open reduction and internal fixation (ORIF) or revision arthroplasty. Differences in treatment and fracture location may be related to patient demographics and lead to differences in cost. Our study examined the effects of demographics and treatment of knee and hip PPFXs on length of stay (LOS) and cost. Methods: Of all, 932 patients were identified with hip or knee PPFXs in the National Inpatient Sample from January 2013 to September 2015. Age, gender, race, mortality, comorbidity level, LOS, total cost, procedure type, geographic region, and hospital type were recorded. A generalized linear regression model was conducted to analyze the effect of fracture type on LOS and cost. Results: Differences in gender (66% vs 83.7% female, P < .01), comorbidities (fewer in hips, P < .01), and costs (US$30 979 vs US$27 944, P < .01) were found between the hip and knee groups. Knees had significantly higher rates of ORIF treatment (80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%) than hip PPFXs ( P < .01). Within both groups, patients with more comorbidities, revision surgery, and blood transfusions were more likely to have a longer LOS and higher cost. Conclusion: Periprosthetic femur fractures patients are not homogenous and treatment varies between hip and knee locations. For knee patients, those treated with ORIF were younger, with fewer comorbidities than those treated with revision. Conversely, hip patients treated with ORIF were older, with more comorbidities than those treated with revision. Hips had higher costs than knees, and cost correlated with revision arthroplasty and more comorbidities. In both hip and knee groups, longer LOS was associated with more comorbidities and being treated in urban teaching hospitals. Total cost had the strongest associations with revision procedures as well as number of comorbidities and blood product use.

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

“…While this study is focused on the potential financial discrepancies between services provided and reimbursement, the National Readmission Database that was used for this dataset does not measure the true total cost of a bundle of care. Other data elements that have been shown to be accurate surrogates for cost such as readmission rate 8 and length of stay (R 2 = .77), 1 , 23 as well as others such as comorbidities and chronic diagnoses, were used to approximate expenses and the variety of costs when stratified with different approaches. Although the NRD lacks data from the post-acute perspective such as outpatient, home care, and skilled nursing facilities, this study focused on the hospital cost and readmission numbers.…”

Periprosthetic knee fractures in an elderly population: open reduction and internal fixation vs distal femur megaprostheses

“…However, this decisional process is limited by the absence of solid clinical evidence due to the lack of comparative studies for these existing techniques. 6,14 The purpose of this study is to evaluate the outcome in patients treated with mega prostheses or internal fixation in periprosthetic fractures of the distal femur in our experience at Policlinico Gemelli. 10…”