Factors influencing results and complications in proximal periprosthetic femoral fractures: a retrospective study at 1- to 8-year follow-up.

Factors influencing results and complications in proximal periprosthetic femoral fractures: a retrospective study at 1- to 8-year follow-up.



periprosthetic fractures, femoral fixation, revision, hip arthroplasty


Background and aim: Proximal periprosthetic femoral fractures (PPFFs) are gradually increasing and surgical management is often associated to high risk of complications, due to elderly population and associated comorbidities. We retrospectively assessed 79 patients at 1- to 8-years follow-up, focusing on factors that may have affected results and complications.

Methods: Seventy-nine PPFFs were classified according to Vancouver classification in: 4 type B1, 22 type B2, 29 type B3, 24 type C. The average age of the patients was 81.5 year-old (61-95). 37 PPFFs (12 type B2 and 25 type B3) were treated with uncemented tapered fluted revision stems (Link MP Recostruction Stem, Waldermar Link GmbH) and 42 patients with open reduction and internal fixation (ORIF). Patients were clinically and radiographically assessed at a mean 5-year follow-up (1-8 years). Elixhauser Comorbidity index was analysed.

Results: All PPFFs, except two, healed within 10 months. Harris Hip score at follow-up was 65.6 in ORIF group and 79.8 in revision hip group (p<0.05). 35.7% and 32.4% had blood transfusions in ORIF and revision hip group respectively (p> 0.05). 5 patients in ORIF group and 2 patients in revision hip group died within 12 months from surgery (p<0.05).

Conclusions: Both ORIF and hip revision arthroplasty with modular uncemented tapered fluted stems are valid procedures for Vancouver B2 and B3 PPFFs. Restricted weight-bearing, high number of comorbidities with elevated Elixhauser Comorbidity Index and ORIF are associated to high 12-month mortality.


Phruetthiphat OA, Otero JE, Zampogna B, Vasta S, Gao Y, Callaghan JJ. Predictors for readmission following primary total hip and total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 28 (3): 2309499020959160.

Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 2006; 88 (6): 1215-22.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4): 780-5.

Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 2016; 98-B (4): 461-7. Erratum in: Bone Joint J 2020; 102-B (12): 1782.

Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011; 25 Suppl 2: S66-70.

Bissias C, Kaspiris A, Kalogeropoulos A, et al. Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16 (1): 15.

Chatziagorou G, Lindahl H, Kärrholm J. Surgical treatment of Vancouver type B periprosthetic femoral fractures: patient characteristics and outcomes of 1381 fractures treated in Sweden between 2001 and 2011. Bone Joint J 2019; 101-B (11): 1447-58.

Rubin LE, Blood TD, Defillo-Draiby JC. Total Hip and Knee Arthroplasty in Patients Older Than Age 80 Years. J Am Acad Orthop Surg 2016; 24 (10): 683-90.

Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293-304.

Reeves RA, Schairer WW, Jevsevar DS. The national burden of periprosthetic hip fractures in the US: costs and risk factors for hospital readmission. Hip Int 2019; 29 (5): 550-7.

Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J. Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am 2005; 87 (3): 570-6.

Ragland K, Reif R, Karim S, et al. Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision. Geriatr Orthop Surg Rehabil 2020; 11: 2151459320939550.

Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979; 141: 17-27.

van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 2009; 47 (6): 626-33

Lee SR, Bostrom MP. Periprosthetic fractures of the femur after total hip arthroplasty. Instr Course Lect 2004; 53: 111-8.

Zheng L, Lee WY, Hwang DS, Kang C, Noh CK. Could Patient Undergwent Surgical Treatment for Periprosthetic Femoral Fracture after Hip Arthroplasty Return to Their Status before Trauma? Hip Pelvis 2016; 28 (2): 90-7.

Patsiogiannis N, Kanakaris NK, Giannoudis PV. Periprosthetic hip fractures: an update into their management and clinical outcomes. EFORT Open Rev 2021; 6 (1): 75-92.

Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E. Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg 2020; 140 (10): 1381-94.

Khan T, Middleton R, Alvand A, Manktelow ARJ, Scammell BE, Ollivere BJ. High mortality following revision hip arthroplasty for periprosthetic femoral fracture. Bone Joint J 2020; 102-B (12): 1670-4.

Young SW, Walker CG, Pitto RP. Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 2008; 79 (4): 483-8.

Gibbs VN, McCulloch RA, Dhiman P, et al. Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture. Bone Joint J 2020; 102-B (5): 580-5.

Moore BJ, White S, Washington R, Coenen N, Elixhauser A. Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index. Med Care 2017; 55 (7): 698-705.

Kim CY, Sivasundaram L, LaBelle MW, Trivedi NN, Liu RW, Gillespie RJ. Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index. J Shoulder Elbow Surg 2018; 27 (10): 1748-55.

Kim D, Jo H, Lee Y, Kim KO. Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study. Acute Crit Care 2020; 35 (1): 10-5.

Varady NH, Gillinov SM, Yeung CM, Rudisill SS, Chen AF. The Charlson and Elixhauser Scores Outperform the American Society of Anesthesiologists Score in Assessing 1-year Mortality Risk After Hip Fracture Surgery. Clin Orthop Relat Res 2021.

Boesmueller S, Michel M, Hofbauer M, Platzer P. Primary cementless hip arthroplasty as a potential risk factor for non-union after long-stem revision arthroplasty in periprosthetic femoral fractures. Int Orthop 2015; 39 (4): 617-22.

Zuurmond RG, van Wijhe W, van Raay JJ, Bulstra SK. High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases. Injury 2010; 41 (6): 629-33.

Chakrabarti D, Thokur N, Ajnin S. Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures-Our experience and identification of a subset at risk of non-union. Injury 2019; 50 (12): 2301-5.

Park JS, Hong S, Nho JH, Kang D, Choi HS, Suh YS. Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures. Acta Orthop Traumatol Turc 2019; 53 (1): 24-9.

Tsiridis E, Spence G, Gamie Z, El Masry MA, Giannoudis PV. Grafting for periprosthetic femoral fractures: strut, impaction or femoral replacement. Injury 2007; 38 (6): 688-97.

Abdel MP, Lewallen DG, Berry DJ. Periprosthetic femur fractures treated with modular fluted, tapered stems. Clin Orthop Relat Res 2014; 472 (2): 599-603.

Parry JA, Hernandez NM, Berry DJ, Abdel MP, Yuan BJ. Risk Factors for Subsidence of Modular Fluted Tapered Stems Used During Revision Total Hip Arthroplasty for Periprosthetic Hip Fractures. J Arthroplasty 2018; 33 (9): 2967-70.

Moreta J, Aguirre U, de Ugarte OS, Jáuregui I, Mozos JL. Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury 2015; 46 (2): 292-8.

Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res 2014; 472 (2): 590-8.




How to Cite

Concina C, Crucil M, Gherlinzoni F. Factors influencing results and complications in proximal periprosthetic femoral fractures: a retrospective study at 1- to 8-year follow-up. . Acta Biomed [Internet]. 2021 Jul. 26 [cited 2024 Jul. 14];92(S3):e2021022. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/11734