Session X - Geriatrics
Sun., 10/10/04 Geriatrics, Paper #63, 8:59 am
Morbidity and Mortality Associated with Periprosthetic Fractures of the Femur
Purpose: Periprosthetic femur fractures represent a common acute and delayed complication of hip and knee arthroplasty. This injury has become more prevalent as the elderly population increases and more joint arthroplasties are performed.
Methods: This is a single-surgeon prospective cohort-control study of patients with periprosthetic femur fractures involving total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 1995 through 2004. We reviewed 93 periprosthetic fractures in 90 patients, of whom 69% had a THA and 31% had a TKA. We evaluated fracture healing, length of hospital stay, intra-operative time-motion analysis, fracture healing, morbidity, mortality, and complications.
Results: The average patient age was 80 years; 19% were male and 81% were female. The average duration from arthroplasty to periprosthetic fracture was 6.7 years. Mean follow-up was 3.5 years. The mechanism of injury was a fall (86%), a motor vehicle accident (9%), insufficiency (2.6%), and iatrogenic intraoperative (2.6%). One hundred percent of THA periprosthetic fractures were treated with plate fixation. Seventy-five percent of fractures proximal to a TKA were treated with plate fixation, and 25% with a retrograde intramedullary nail. The average surgical time was 90 minutes, and the average estimated blood loss was 500 cc. Complications resulting from periprosthetic fractures were a fatal pulmonary embolism (1%) 8 days after surgery, deep vein thrombosis (3%), and nonunion (4%). There were no postoperative infections. The average length of hospital stay was 9 days. Average time to weightbearing was 83 days. The rate of union was 96%. Twenty-seven patients (35%) died within an average of 1.4 years from the index procedure.
Conclusion: Our data revealed an improved fracture union rate and decreased complication rate compared with historical controls. However, despite careful surgical management, periprosthetic femur fracture remains a morbid injury, showing a significant mortality rate within the first 24 months after injury. It presents significant technical challenges to the orthopaedic surgeon.