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Impact of surgical timing and type of operative procedure on outcomes in periprosthetic hip fractures: an observational study at an NHS trust centre in the UK

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

There is a global trend of increased periprosthetic fractures due to the growing number of arthroplasty procedures. The present study assessed the impact of factors such as time to surgery and type of surgery on the outcomes, which have been seldom evaluated for periprosthetic fractures.

Methods

An observational study was conducted on consecutive 87 patients within an NHS district hospital trust in the UK. Patients who underwent a complete hip replacement prior to the fracture, received fixation therapy, or underwent revision surgery within the specified time were screened. Patients were grouped in two ways: based on time to surgery and based on surgery type. Logistic regression models were performed to assess for statistically significant differences in post-operative complication, 30-day, and 1-year mortality rates between groups, whilst adjusting for age, gender, and ASA grade.

Results

Forty-one patients underwent open reduction and internal fixation (ORIF), 29 patients underwent revision arthroplasty, and 17 patients were subjected to both, ORIF and revision arthroplasty. Sixty of the 87 patients were operated on > 48 h of injury. The median hospital stay was significantly lower in the ORIF plus revision arthroplasty group, versus other surgical groups (p < 0.05) whilst it was significantly higher in the group of patients who underwent surgery after 48 h of injury (p < 0.05). Numerically higher mortality was noted in the revision arthroplasty group (31.03%, p > 0.05). The group that was operated after 48 h of injury showed greater mortality but was comparable to the other group (25% vs. 14.81%, p > 0.05). For post-operative complications, none of the variables were significantly predictive (p > 0.05). However, for 30-day mortality, ASA grade (p = 0.04) and intra-operative complications (p = 0.0001) were significantly predictive. Additionally, for 1-year mortality, ASA grade (p = 0.004) was noted to be significantly predictive.

Conclusion

Revision and delayed periprosthetic fracture management (> 48 h after injury) group showed a numerically greater mortality risk; however, this finding was not statistically significant. ASA grading at baseline is predictive of mortality for periprosthetic fractures.

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Acknowledgements

Kritarth Naman Singh performed statistical analysis and regression studies.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Trauma and Orthopaedic Surgery, Royal Lancaster Infirmary, Lancaster, UK

    Abhimanyu Singh, Srikanth Gandavaram, Kuntal Patel & Deepak Herlekar

  2. Trauma and Orthopaedics Surgery, Wrexham Maelor Hospital, Wrexham, UK

    Amit Singh

Authors
  1. Abhimanyu Singh
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  2. Amit Singh
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  3. Srikanth Gandavaram
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  4. Kuntal Patel
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  5. Deepak Herlekar
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Contributions

All authors contributed to the study’s conception and design. Abhimanyu Singh and Amit Singh performed material preparation, data collection, and analysis. Abhimanyu Singh wrote the manuscript's first draft, and all authors commented on the previous versions. All authors read and approved the final manuscript.

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Correspondence to Abhimanyu Singh.

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The authors do not have any relevant conflicts of interest to disclose.

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This is an observational study. The trust ethics committee has confirmed that no ethical approval is required.

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Singh, A., Singh, A., Gandavaram, S. et al. Impact of surgical timing and type of operative procedure on outcomes in periprosthetic hip fractures: an observational study at an NHS trust centre in the UK. Eur J Orthop Surg Traumatol 34, 2099–2105 (2024). https://doi.org/10.1007/s00590-024-03900-2

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  • DOI: https://doi.org/10.1007/s00590-024-03900-2

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