Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures.

Abstract

Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF). We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications. Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality. Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.