Outcome of surgical treatment of 54 periprosthetic femoral fractures after total hip arthroplasty at mid term follow-up

BACKGROUND AND AIM: The incidence of periprosthetic femoral fractures (PFF) is increasing, as the incidence of total hip arthroplasty (THA) and the longevity of patients with in situ implants are increasing. PFF are characterized by remarkably high re-operation and mortality rates and substantial loss in function. Therefore, the aim of the present study was to review the outcome of the surgical treatment of 54 PFF after THA at a mean follow-up of 45 months. METHODS: We retrospectively reviewed 54 surgically treated patients with PFF after THA from January 2005 to Dicember 2015 at a mean follow-up of 45 months (range 12-135 months). At final follow-up, the clinical outcome was measured using the Harris Hip score (HHS), the Karnofsky score (KS), while, the radiographic results were evaluated using the Beals and Tower’s criteria. RESULTS: There were 13 post-operative complications that occurred in 10 patients with an overall re-operation rate of 11%. The mortality rate was 0% at 3 months and 3.7% at one year post-operatively. At final follow-up, the mean HHS was 64 (range 20-100) and the mean KS was 66 (range 30-100). The mean last HHS and KS of patients older than 75 years or with co-morbidities were lower than that of patients younger than 75 years or without co-morbidities (p<0.05). Fracture type according to the Vancouver classification, surgical treatment (open reduction internal fixation (ORIF) vs stem revision), complications, only re-operations and only dislocations had no effect on clinical outcome (p>0.05). There were no differences of the mean last HHS and KS of ORIF compared to stem revision of type B2 and B3 fractures (p>0.05). The radiolographic results were excellent in 89%, good in 9% and poor in 2% of patients. CONCLUSIONS: Although this study have shown that the surgical treatment of PFF was associated with a low re-operative rate, a good to excellent radiolographic results and a low mortality rate at 3 months and 1 year postoperatively, there was a marked functional deterioration in many patients. This decline of function could be attributed to the advanced age of patients and the presence of co-morbidities, whereas, fracture type according to the Vancouver classification, surgical treatment and complications had no effect. In this cohort of patients, ORIF could be a valid option for treating B2 and B3 type fractures with loosened stem.