Abstract
Objectives
To examine patient mortality, implant survivorship, and complication profiles of proximal femoral replacement (PFR) as compared to revision total hip arthroplasty (REV) or open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur.
Methods
We performed a retrospective controlled chart review at our tertiary center from from 2000–2010, identifying 97 consecutive acute periprosthetic proximal femoral fractures. Patients were stratified into three treatment groups: PFR (n=21), REV (n=19), and ORIF (n=57). Primary outcome measures included death, implant failure, and reoperation. We also recorded patient demographics, medical comorbidities, fracture type, treatment duration, time to treatment, and complication profiles. Statistical analyis included competing risks survival, which allows independent survival analysis of competing failure mechanisms such as death and implant failure.
Results
Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no difference between the three groups (p=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (p=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 93%, 93%; ORIF 98%, 98%). Comparing PFR to REV and ORIF, PFR had a trend towards higher dislocation (19% vs. 5% vs. 4%, p=0.06). There was no difference between groups with regard to summary non-death complications including DVT, infection, dislocation, and other measures (30% vs. 40% vs. 34%, p=0.80). Operative times were not different between groups (172 min. vs. 162 min. vs. 168 min, p=0.92).
Conclusions
In treating difficult periprosthetic fractures, PFR as compared with REV or ORIF has worse medium-term implant survival, primarily due to instability and dislocation. The groups had similar perioperative complication rates, similar short and long term mortality, and similar operative times.
