Periprosthetic femoral fractures following bipolar hemiarthroplasty: A descriptive multicenter study exploring associations with mortality and functional status.

Abstract

Periprosthetic femoral fractures (PFFs) following bipolar hemiarthroplasty (BHA) represent a major complication in elderly patients with frailty and poor bone quality. However, limited data exist on the relationship between fracture type and clinical outcomes such as mortality and functional status in this population. This multicenter retrospective study included 157 patients who sustained a PFF following BHA for femoral neck fractures between 2010 and 2023. Fractures were classified using the Vancouver classification. Clinical variables included age, sex, comorbidities (Charlson Comorbidity Index, CCI), dementia, coexisting fragility fractures, pre-injury mobility, and treatment modality. One-year mortality and postoperative functional outcomes were assessed using Kaplan-Meier survival analysis, the Parker Mobility Score (PMS), and Merle d'Aubigné score. The one-year mortality rate was 31.4 %. Higher mortality was significantly associated with CCI ≥2, dementia, and coexisting vertebral or pelvic fragility fractures (p < 0.05). In contrast, no significant differences in one-year mortality or postoperative functional scores were observed across Vancouver classification types or treatment methods. Functional recovery was similarly limited regardless of fracture type. In this multicenter retrospective cohort of patients with periprosthetic femoral fractures following bipolar hemiarthroplasty, the 1-year mortality was high at approximately 30 %. Outcomes appeared to be driven primarily by systemic factors-greater comorbidity burden, cognitive impairment, and concomitant fragility fractures. These findings underscore the importance of comprehensive geriatric assessment and proactive osteoporosis management in this vulnerable population.