Early complications after surgery for periprosthetic femoral fractures: incidence, risk factors, and clinical implications.

Abstract

Periprosthetic femoral fractures (PFF) are the second cause of revision surgery after total hip arthroplasty and occur predominantly in elderly, fragile patients. Despite high associated morbidity and mortality, data specifically focusing on early postoperative complications remain scarce. A single-center retrospective study was conducted on 192 patients who underwent surgery for PFF between January 2010 and April 2023. Patients were treated by open reduction and internal fixation (ORIF, n = 75) or revision surgery (n = 117). All complications occurring within the first postoperative month were recorded and categorized as general, mechanical, or septic. Univariate and multivariate logistic regression analyses were performed to identify factors associated with their occurrence. The mean age was 82.1 years. 126 complications were observed in 70 patients (36.5%) within the first month. General complications were the most frequent (75.4%), predominantly pulmonary and urinary infections, leading to a 7.3% early mortality rate. Mechanical complications occurred in 5 patients (2.6%) and periprosthetic joint infection (PJI) in 12 patients (6.3%), with S. aureus responsible for 66.7% of infections. In multivariate analysis, preoperative infection was independently associated with early mortality (OR = 3.47; p = 0.01) and early PJI (OR = 2.40; p < 0.001) in the ORIF group, while alcoholism was correlated with early mortality (OR = 1.70; p = 0.02). Weight-bearing restrictions were significantly associated with mechanical complications in the revision group (OR = 2.87; p < 0.01). Early complications following PFF surgery are frequent and severe, reflecting the extreme frailty of this patient population. Preoperative infection control and an individualized approach to postoperative weight-bearing appear as key modifiable factors to improve early outcomes. A multidisciplinary, patient-centered management strategy is essential in this complex surgical setting.