Background:

Mortality following revision hip surgery for periprosthetic fracture (PPF) is comparable to neck of femur fractures. Our institution provides a regional “PPF Service”. The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to revision for infection or aseptic loosening.

Methods:

Revision arthroplasty procedures performed for PPF, infection or aseptic loosening between January 2014 and December 2015 were identified. Comparisons were made between the 3 groups for baseline demographics, admission to higher-level care, length of stay, complications and mortality.

Results:

There were 37 PPF, 71 infected and 221 aseptic revisions. PPF had a higher proportion of females (65% vs. 39% in infection and 53% in aseptic; p = 0.031) and grade 3 and 4 ASA patients (p = 0.006). Median time to surgery for PPF was 8 days (95% CI, 6–16). Single-stage procedures were performed in 84% of PPF, 42% of infections and 99% of aseptic revisions (p < 0.001). 19% of PPF revisions required HDU admission, 1% in the aseptic group and none in the infection group. Median length of stay was significantly different (PPF 10; infection 14; aseptic 8 days (p < 0.001). The 1-year mortality rate for PPF was 0%, 2.8% for infection and 0.9% in the aseptic group (p = 0.342).

Conclusions:

Despite the PPF group having higher ASA grades and more HDU admissions, our 1-year mortality rate was 0% and not significantly different to infection or aseptic loosening. Our low complication and 1-year mortality rate is encouraging and supports the safety of a regional “Periprosthetic Fracture Service”.

中文翻译：

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假体周围骨折、感染或无菌性松动进行髋关节翻修术后死亡率的比较

背景：

假体周围骨折（PPF）髋关节翻修手术后的死亡率与股骨颈骨折相当。我们的机构提供区域性“PPF 服务”。本研究的目的是确定与感染或无菌性松动修复相比，PPF 的手术时间和死亡率。

方法：

确定了 2014 年 1 月至 2015 年 12 月期间因 PPF、感染或无菌性松动而进行的翻修关节成形术。对三组的基线人口统计数据、接受更高级别护理、住院时间、并发症和死亡率进行了比较。

结果：

共有 37 例 PPF、71 例感染和 221 例无菌翻修。PPF 中女性比例较高（感染者为 65%，感染者为 39%，无菌者为 53%；p  = 0.031）以及 3 级和 4 级 ASA 患者（p  = 0.006）。PPF 手术的中位时间为 8 天（95% CI，6-16）。84% 的 PPF、42% 的感染和 99% 的无菌翻修进行了单阶段手术 ( p  < 0.001)。19% 的 PPF 修正需要 HDU 入院，无菌组中有 1%，感染组则没有。中位住院时间有显着差异（PPF 10；感染 14；无菌 8 天（p  < 0.001）。PPF 的 1 年死亡率为 0%，感染为 2.8%，无菌组为 0.9%（p  = 0.342） ）。

结论：

尽管 PPF 组 ASA 等级较高且 HDU 入院人数较多，但我们的 1 年死亡率为 0%，与感染或无菌性松动没有显着差异。我们的低并发症率和一年死亡率令人鼓舞，并支持区域“假体周围骨折服务”的安全性。