Long term outcomes in periprosthetic femoral fractures: Experience from a UK district general hospital with a weekly dedicated periprosthetic theatre list and MDT approach.

Abstract

Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22-27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital. We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (n = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies. Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (n = 3), 30-day mortality 3.5 %(n = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (n = 87) returned to their original place of residence. A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.