Top

Archives of Orthopaedic and Trauma Surgery

Published in:

Open Access 01-08-2021 | Periprosthetic Fracture | Hip Arthroplasty

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Authors: L. Farrow, A. D. Ablett, H. W. Sargeant, T. O. Smith, A. T. Johnston

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2021

Abstract

Introduction

Previous evidence has established that early surgery is beneficial to improve outcomes for individuals with native hip fractures in the elderly population. Patients who sustain a periprosthetic fracture have been demonstrated to have similar demographics and outcomes as those with native fractures around the hip and knee. We therefore set out to determine if there is a similar difference in perioperative outcomes between early and delayed surgery for periprosthetic fractures of the hip and knee through a systematic review and meta-analysis.

Methods

Literature search outputs were screened for studies meeting the inclusion criteria. The groups of early surgery and delayed surgery were defined by study authors. The primary outcome measure was 30 day mortality. Where there was sufficient study homogeneity, a random-effects meta-analysis was performed. Individual study risk of bias was assessed using the ROBINS-I criteria, with the GRADE criteria used for independent outcome evaluation. The review protocol was registered on PROSPERO prior to commencement (Registration number CRD42019149360).

Results

The inclusion criteria was met in 11 studies (n = 3006). Mean time to surgery from admission for reporting studies was 64 h. 59.6% patients underwent early surgery as defined by the study authors. We identified a significantly lower risk of 30 day mortality for those with early surgery versus delayed surgery (RR 0.21; 95% CI 0.05, 0.90; p = 0.04, n = 2022). There were also significantly better outcomes for early versus delayed surgery regarding: medical complications, length of stay, transfusion risk, and reoperation. The quality of evidence for all the individual outcomes was low or very low.

Conclusions

There is evidence that delaying surgery in those with periprosthetic fractures of the hip and knee has a deleterious impact on mortality and other important patient outcomes. There are, however, notable limitations to the existing available literature, with further appropriately designed large-scale studies required to confirm these findings.

Available only for authorised users

Review Manager (RevMan) [Computer program]. Version 5.3 (2014) The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen

PHS (2018) Scottish standards of care for hip fracture patients. https://www.shfa.scot.nhs.uk/_docs/2018/Scottish-standards-of-care-for-hip-fracture-patients2018.pdf

Atkins D, Best D, Briss PA et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328(7454):1490CrossRef

Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H (2007) Mortality after periprosthetic fracture of the femur. J Bone Jt Surg Am 89(12):2658–2662CrossRef

BOA, BGS, NHFD, FFN (2019) BOAST: the care of the older or frail orthopaedic trauma patient. https://www.bgs.org.uk/sites/default/files/content/attachment/2019-06-03/BOA%20FFN%20BGS%20BOAST_0.pdf

Boddapati V, Grosso MJ, Sarpong NO, Geller JA, Cooper HJ, Shah RP (2019) Early morbidity but not mortality increases with surgery delayed greater than 24 hours in patients with a periprosthetic fracture of the hip. J Arthroplast 34(11):2789 e2781-2792 e2781CrossRef

Boddapati V, Held MB, Lee NJ, Geller JA, Cooper HJ, Shah RP (2019) Is the time to revision surgery after peri-prosthetic fracture of the knee associated with increased rates of post-operative complications? Arthroplast Today 5(3):348–351CrossRef

Bovonratwet P, Fu MC, Adrados M, Ondeck NT, Su EP, Grauer JN (2019) Unlike native hip fractures, delay to periprosthetic hip fracture stabilization does not significantly affect most short-term perioperative outcomes. J Arthroplast 34(3):564–569CrossRef

Eschbach D, Buecking B, Kivioja H et al (2018) One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes? Injury 49(6):1176–1182CrossRef

10.

Fuchtmeier B, Galler M, Muller F (2015) Mid-term results of 121 periprosthetic femoral fractures: increased failure and mortality within but not after one postoperative year. J Arthroplast 30(4):669–674CrossRef

11.

Gibbs VN, McCulloch RA, Dhiman P et al (2020) Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture. Bone Jt J 102-B(5):580–585CrossRef

12.

Griffiths EJ, Cash DJ, Kalra S, Hopgood PJ (2013) Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures. Injury 44(12):1949–1952CrossRef

13.

Hoellwarth JS, Fourman MS, Crossett L et al (2018) Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury 49(2):392–397CrossRef

14.

Jennison T, Yarlagadda R (2018) Mortality in patients sustaining a periprosthetic fracture following a hemiarthroplasty. J Orthop 15(3):798–801CrossRef

15.

Jennison T, Yarlagadda R (2018) Mortality in patients sustaining a periprosthetic fracture following a previous extracapsular hip fracture fixation. Injury 49(3):702–704CrossRef

16.

Johnson-Lynn S, Ngu A, Holland J, Carluke I, Fearon P (2016) The effect of delay to surgery on morbidity, mortality and length of stay following periprosthetic fracture around the hip. Injury 47(3):725–727CrossRef

17.

Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow AR, Pearson RG (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J 99-B(4 Supple B):17–25CrossRef

18.

Lee SR, Shrestha K, Staggers J, Li P, Naranje SM, Shah A (2018) Impact of time to surgery from injury on postoperative infection and deep vein thrombosis in periprosthetic knee fractures. Chin J Traumatol 21(6):329–332CrossRef

19.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef

20.

Myers P, Laboe P, Johnson KJ et al (2018) Patient mortality in geriatric distal femur fractures. J Orthop Trauma 32(3):111–115CrossRef

21.

Orfanos G, Lim J, Youssef B (2019) Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties. Arch Orthop Trauma Surg 139(4):475–482CrossRef

22.

Pivec R, Issa K, Kapadia BH et al (2015) Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty: an analysis of international registry data. J Long Term Eff Med Implants 25(4):269–275CrossRef

23.

RCP (2016) National hip fracture database annual report 2016. http://web1.crownaudit.org/Report2016/NHFD2016Report.pdf

24.

Sellan ME, Lanting BA, Schemitsch EH, MacDonald SJ, Vasarhelyi EM, Howard JL (2018) Does time to surgery affect outcomes for periprosthetic femur fractures? J Arthroplast 33(3):878–881CrossRef

25.

Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55(3):146–154CrossRef

26.

Sterne JA, Hernan MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRef

27.

Taylor M, Hopman W, Yach J (2016) Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room. Can J Surg 59(5):337–341CrossRef

28.

Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Jt Surg Br 87(3):361–366CrossRef

29.

Zanardi DM, Parpinelli MA, Haddad SM et al (2019) Adverse perinatal outcomes are associated with severe maternal morbidity and mortality: evidence from a national multicentre cross-sectional study. Arch Gynecol Obstet 299(3):645–654CrossRef

Title: Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis
Authors: L. Farrow
A. D. Ablett
H. W. Sargeant
T. O. Smith
A. T. Johnston
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keyword: Periprosthetic Fracture
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03739-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2021

Total hip arthroplasty after periacetabular osteotomy versus primary total hip arthroplasty: a propensity-matched cohort study

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

Results following prolonged recovery show satisfactory functional and patient-reported outcome after intramedullary nailing of a tibial shaft fracture: a prospective 5-year follow-up cohort study

Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state

Additional acromioclavicular cerclage limits lateral tilt of the scapula in patients with arthroscopically assisted coracoclavicular ligament reconstruction

Minimally invasive lumbopelvic stabilization of sacral fragility fractures in immobilized geriatric patients: feasibility and early return to mobility