Alarmingly High Rates of Complications and Refracture Among Patients with Early Periprosthetic Femoral Fracture Within 30 Days After THA.

Abstract

The purpose of this study was to compare the outcomes of patients who underwent a total hip arthroplasty (THA) and sustained a postoperative periprosthetic femoral fracture either within the early postoperative period, within 30 days, or at later time points. A large, all-payer national database was queried to identify patients who underwent a primary THA between 2010 and 2022. Patients who underwent a primary THA and sustained a periprosthetic femoral fracture within 30 days postoperatively were propensity-score matched on the basis of age, sex, and comorbidity burden to 3 separate cohorts based on timing: fracture between 31 and 90 days postoperatively (n = 1,725), fracture between 91 days and 1 year (n = 1,887), and no fracture within 1 year (n = 4,465). The 30-day fracture group had a mean age of 66.63 ± 10.15 years, and 75% of patients in this group were female. Regression analyses were utilized to evaluate outcomes at 90 days and 2 years. Survivorship analyses utilizing death as a competing end-point were conducted for rates of infection, refracture, and reoperation at up to 2 years. Patients who sustained a periprosthetic femoral fracture within 30 days after primary THA demonstrated significantly greater rates of complications within 90 days relative to each comparison cohort. The 2-year survivorships free of refracture and reoperation were significantly lower (p < 0.05) for the early fracture cohort relative to matched patients who sustained a fracture at other time points. Additionally, 2-year survivorships were poorer in the ≤30-day cohort than in the comparison cohort who had not sustained a fracture within 1 year postoperatively: survivorships free of infection (87.8% [95% confidence interval (CI), 86.8% to 88.8%] compared with 97.7% [95% CI, 97.3% to 98.1%]), refracture (57.4% [95% CI, 56.0% to 58.9%] compared with 99.5% [95% CI, 99.3% to 99.7%]), and reoperation (48.5% [95% CI, 47.1% to 50.0%] compared with 97.6% [95% CI, 97.2% to 98.1%]) were all significantly lower (p < 0.05). Patients who sustained an early periprosthetic femoral fracture within 30 days following primary THA were at significantly greater risk for complications than patients who sustained a periprosthetic femoral fracture at later time points. The exceedingly high rates of complications compared with patients without a periprosthetic femoral fracture stresses the importance of not only prevention but potential interventions both perioperatively and postoperatively in an attempt to mitigate the risk of complications for these at-risk patients. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.