Predictive factors for reoperation after periprosthetic femoral fracture: A retrospective multicenter (TRON) study

Manato Iwata; Yasuhiko Takegami; Katsuhiro Tokutake; Hiroshi Kurokawa; Hideomi Takami; Satoshi Terasawa; Tetsuro Takatsu; Shiro Imagama

doi:10.1016/j.jos.2023.11.016

Predictive factors for reoperation after periprosthetic femoral fracture: A retrospective multicenter (TRON) study

J Orthop Sci. 2023 Dec 14:S0949-2658(23)00330-5. doi: 10.1016/j.jos.2023.11.016. Online ahead of print.

Authors

Manato Iwata¹, Yasuhiko Takegami², Katsuhiro Tokutake³, Hiroshi Kurokawa¹, Hideomi Takami¹, Satoshi Terasawa¹, Tetsuro Takatsu⁴, Shiro Imagama¹

Affiliations

¹ Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: takegami@med.nagoya-u.ac.jp.
³ Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁴ Department of Orthopaedic Surgery, Gifu Prefactual Tajimi Hospital, Tajimi, Japan.

PMID: 38097462
DOI: 10.1016/j.jos.2023.11.016

Abstract

Background: The surgical treatment of periprosthetic femoral fracture (PFF) can be technically demanding and it is associated with high rates of complications and repeat surgery. However, repeat surgery is uncommon and few studies have examined survival and the functional prognosis following reoperation after the surgical treatment of PFF. We aimed to estimate the rate of reoperation for any reason, to determine the survival rate after reoperation for PFF, and to identify predictors associated with reoperation after PFF surgery in a multicenter (TRON group) study.

Methods: Two hundred forty-six patients were admitted for treatment of PFF. After excluding patients managed conservatively and those with Vancouver type A fracture, we analyzed 184 patients. Unadjusted risk ratios (RRs) were calculated, and multiple logistic regression was used to calculate adjusted RRs. We used the Kaplan-Meier method to create survival curves and a log-rank test to determine survival from the date of repeat surgery.

Results: Fifteen of the 184 patients (8.2 %) underwent reoperation after PFF surgery. The 1-year survival rate after reoperation for PFF was 66.7 % (11 of 15). Vancouver B3 and Vancouver C were identified as independent risk factors for reoperation after PFF surgery (Vancouver B3: Risk ratio [RR] 19.0, 95 % CI 1.10-329 P < 0.001; Vancouver C: RR 13.3, 95 % CI 1.4-123.0, P = 0.023).

Conclusion: The reoperation rate after PFF surgery and the mortality after reoperation PFF surgery were relatively high. The fracture type is associated with reoperation after PFF surgery.

Keywords: Mortality; Periprosthetic femoral fracture; Reoperation.