How have management and outcomes of periprosthetic proximal femoral fractures changed? A comparison of two 8 year time periods in a high volume centre

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• Picked for Orthopedics and Sports Medicine (paper of the day, 25 October 2026): Fracture management trends and outcomes after hip arthroplasty

Abstract

BACKGROUND: Periprosthetic femoral fractures (PFFs) are now the leading cause of major reoperation following total hip arthroplasty (THA). Patients are often frail and surgeries increasingly complex. We reviewed PFFs over two consecutive 8-year periods to analyse trends in incidence, management and outcomes to assess the evolving clinical and service impacts. METHODS: A retrospective review was conducted using data from the Fracture Outcomes Research Database (FORD) and the National Hip Fracture Database (NHFD) across two 8-year periods (2007-2015 and 2016-2024). Radiographic and clinical records were reviewed. Fracture classification, management, comorbidities and mortality were recorded and compared. A regression analysis was performed to determine co-morbidities that significantly increased the risk of 12-month mortality. In the 2016-2024 period, data on re-operations rates were recorded. RESULTS: PFF increased from 189 to 320 across the two periods, totalling 509 patients. The incidence of Vancouver B2 fractures increased more than 1.5x, rising from 42/189 (22.2%) to 117/320 (36.6%) patients. Fixation remained the most common treatment across the two periods (75.1% and 63.4%), while revision arthroplasty was performed in 22.8% and 18.4% respectively. B2 fracture management changed significantly with fixation increasing (59% v 9.5%; p < 0.001) and revision arthroplasty rates decreasing (38.5% vs 85.7%; p < 0.001). Time to theatre improved (5-3.7 days; p = 0.028) and a higher proportion of patients returned to their pre-injury residence (30.2%; 57/189 vs 39%; 96/320, p = 0.068). No difference in mortality was observed at 30 days (2.6-3.1%; p = 0.796) or 90 days (5.8% vs 9.1%; p = 0.233) but mortality was higher at 12 months (12.2-20%; p = 0.028). ASA 4 patients increased (14%; 25/179; vs 29.1%; 82/282, OR = 2.526 (95% CI 1.54-4.14), p < 0.001). Re-operation rates were lower in the fixation group than in the revision group (12; 5.9% vs 8; 13.6%; p = 0.095). CONCLUSION: The incidence and mortality associated with PFFs are rising within our unit, despite improved time to theatre and improved discharge outcomes. This trend may reflect a frailer cohort with higher ASA grades. We demonstrate a shift in practice, with more B2 fractures treated with fixation, achieving good outcomes suggesting fixation may be a safe treatment option in selected frail patients.

Abstract as published, via PubMed.