Peri-prosthetic femoral fractures of hip or knee arthroplasty. Analysis of 34 cases and a review of Spanish series in the last 20 years

Abstract

Purpose: To evaluate peri-prosthetic femoral fractures by analysing type of patient, treatment and outcomes, and to compare them with Spanish series published in the last 20 years.

Material and methods: A retrospective review of the medical records of patients with peri-prosthetic femoral fractures treated in our hospital from 2010 to 2014, and telephone survey on the current status.

Results: A total of 34 peri-prosthetic femoral fractures were analysed, 20 in hip arthroplasty and 14 in knee arthroplasty. The mean age of the patients was 79.9 years, and 91% had previous comorbidity, with up to 36% having at least 3 prior systemic diseases. Mean hospital stay was 8.7 days, and was higher in surgically-treated than in conservative-treated patients. The majority (60.6%) of patients had complications, and mortality was 18%. Functional status was not regained in 61.5% of patients, and pain was higher in hip than in knee arthroplasty.

Discussion: Peri-prosthetic femoral fractures are increasing in frequency. This is due to the increasing number of arthroplasties performed and also to the increasing age of these patients. Treatment of these fractures is complex because of the presence of an arthroplasty component, low bone quality, and comorbidity of the patients.

Conclusion: Peri-prosthetic femoral fractures impair quality of life. They need individualised treatment, and have frequent complications and mortality.

Keywords: Femur; Fracturas periprotésicas; Fémur; Hip arthroplasty; Knee arthroplasty; Peri-prosthetic fracture; Prótesis cadera; Prótesis rodilla.