Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures

Griffiths, Edward; Cash, D.J.W.; Kalra, Sanjay; Hopgood, P.

doi:10.1016/j.injury.2013.03.008

Cited by 94 publications

(56 citation statements)

References 18 publications

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“…The higher risk of periprosthetic fractures after cementless THA, especially in the elderly (Makela et al 2014, Thien et al 2014, Lindberg-Larsen et al 2017, is confirmed in our study, amounting to 1.5% after cementless THA compared with 0.2% after cemented/hybrid THA. Periprosthetic fractures may cause protracted mobilization with limited weightbearing and when revision surgery is needed the procedures are complex and often associated with a high risk of complications and mortality (Bhattacharyya et al 2007, Griffiths et al 2013. Our study includes only 30 days' follow-up and hence more periprosthetic fractures, especially after cementless THA, with associated patient morbidity may be recognized later (Lindberg-Larsen et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

et al. 2020

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Background and purpose — The use of cementless total hip arthroplasty (THA) in elderly patients is debated because of increased risk of early periprosthetic femoral fractures. However, cemented femoral components carry a risk of bone cement implantation syndrome. Hence, we compared in-hospital complications, complications leading to readmission and mortality ≤ 30 days postoperatively between hybrid/cemented (cemented femoral component) vs. cementless THA in osteoarthritis patients > 70 years. Patients and methods — This is a prospective observational cohort study in 9 centers from January 2010 to August 2017. We used 30-day follow-up from the Danish National Patient Registry, patient records, and data from the Danish Hip Arthroplasty Register. Only THAs performed as a result of osteoarthritis were included. Results — 3,368 (42%) of the THAs were cemented/hybrid and 4,728 (58%) cementless. The in-hospital complication risk was 7.7% after cemented/hybrid vs. 5.3% after cementless THA (< 0.001), statistically not significant when adjusting for comorbidities (p = 0.1). There were similar risks of complications causing readmission (5.7% vs. 6.2%) and mortality ≤ 30 days (0.2% vs. 0.3%). 15 cases (0.4%) of pulmonary embolism (PE) were found after cemented/hybrid vs. 4 (0.1%) after cementless THA (p = 0.001); none occurred within 24 hours postoperatively. 2 of the PEs after cementless THA led to mortality. Cemented/hybrid THA remained significantly associated with risk of PE (RR 3.9, p = 0.02), when adjusting for comorbidities. BMI > 35 was associated with highest risk of PE (RR 5.7, p = 0.003). The risk of periprosthetic femoral fracture was 0.2% after cemented/hybrid vs. 1.5% after cementless THA (p < 0.001) and the risk of dislocations was 1.2% after cemented/hybrid THA vs. 1.8% after cementless THA (p = 0.04). Interpretation — The higher risk of PE after cemented/hybrid THA and higher risk of periprosthetic femoral fractures and dislocations after cementless THA highlights that both medically and surgically complications are related to fixation technique and have to be considered.

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Section: Discussionmentioning

confidence: 99%

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

et al. 2020

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“…However, the 30-day complication and mortality rates were lower than previously published data. [1][2][3][4][5][6][7][8] Griffiths et al reviewed 60 THA periprosthetic fractures in the United Kingdom and found that 65% of patients were female with a mean age of 78 years. Mean hospital length of stay was 17 days, with a complication rate of 35% and mortality of 10% by the 30-days postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Mean hospital length of stay was 17 days, with a complication rate of 35% and mortality of 10% by the 30-days postoperative period. 4 Drew et al found that 79.8% of the patients were female and had a mean age of 76 years with a mean BMI of 27.7. Mortality at 1 year was 13% with risk or reoperation at 12% in the same cohort.…”

Section: Discussionmentioning

confidence: 99%

“…3 Current literature has shown that patients suffering from a THA or TKA periprosthetic fracture have higher mortality, complication, and reoperation rates than primary THA and TKA. 2,[4][5][6][7][8] Very limited evidence suggests that revision arthroplasty may be associated with lower mortality risk than operative osteosynthesis fixation for fractures with stable implants, although there is no clear consensus on this point. 2,5,7 The majority of data in the literature is based on small cohorts with minimal comparison of outcomes between different surgical management options for THA or TKA periprosthetic fractures.…”

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confidence: 99%

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Comparison of Mortality and 30-Day Complication Rates for Patients Undergoing Fixation versus Revision Arthroplasty after Periprosthetic Fractures of the Hip and Knee

et al. 2018

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Periprosthetic fractures of the hip and knee are often associated with significant morbidity and mortality and may require operative fixation or revision arthroplasty to restore ambulation and functional status. There is scarce literature comparing patient profiles and operative complications between periprosthetic fractures of the hip/knee and the predisposing risk factors. The main study goal is to compare the postoperative complication rates and mortality between operative osteosynthesis fixation and revision arthroplasty while also evaluating the patient characteristics, intraoperative factors, and 30-day postoperative complications of periprosthetic total hip arthroplasty (THA) and total knee arthroplasty (TKA) fractures, as well as patient-related risk factors for serious adverse events. Patients who underwent surgery for periprosthetic fractures around a THA/TKA prosthesis were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2008 and 2015. Preoperative patient demographics and comorbidities, as well as operative factors and 30-day postoperative complications were compared between periprosthetic factures of the hip and those of the knee. A multivariable logistic regression analysis was used to identify patient risk factors for adverse events. Of 1,171 identified patients, patients with THA and TKA periprosthetic fractures had similar characteristics and were more likely female, with age over 70 years and a body mass index of > 25. Both groups had similar 30-day complication rates, with 9.8% of hip patients and 11.2% of knee patients having a postoperative complication. Mortality rate for THA periprosthetic fracture status postrevision or fixation was 3.6% and 3.3% for those with TKA periprosthetic fractures. There was no significant difference in 30-day mortality or postoperative complication rates in periprosthetic fractures treated with operative osteosynthesis fixation versus revision arthroplasty for THA and TKA. Patients with periprosthetic hip and knee arthroplasty fractures can be effectively managed with either operative osteosynthesis fixation or revision arthroplasty when properly indicated, with no significant difference in mortality, complication, or reoperation rates.

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“…The underlying causes have been assessed in several studies and non‐modifiable factors such as age and pre‐existing comorbidities contribute to early death among hip fracture patients . An important modifiable factor is surgical delay as this contributes to worsening of prognosis.…”

Section: Introductionmentioning

confidence: 99%

The association between pre‐operative sepsis and 30‐day mortality in hip fracture patients—A cohort study

Mørch

Tantholdt-Hansen

Pedersen

et al. 2018

Acta Anaesthesiol Scand

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Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures

Cited by 94 publications

References 18 publications

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

Comparison of Mortality and 30-Day Complication Rates for Patients Undergoing Fixation versus Revision Arthroplasty after Periprosthetic Fractures of the Hip and Knee

The association between pre‐operative sepsis and 30‐day mortality in hip fracture patients—A cohort study

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