CRACKS IN THE SYSTEM: THE RISE OF PERIPROSTHETIC TRAUMA

Introduction Periprosthetic fractures (PPFs) are a growing challenge in orthopaedic care. With an aging population and a rise in arthroplasty procedures, formerly straightforward fragility fractures now frequently involve prosthetic implants. This shift demands more theatre time, senior surgical input, and greater hospital resources. Identifying and quantifying this burden is essential for planning orthopaedic workforce and operative capacity. Method We performed a retrospective audit of all PPFs treated operatively at Christchurch Hospital over four 12-month periods spaced five years apart: 2009, 2014, 2019, and 2024. Cases were identified using ICD coding for periprosthetic fractures and procedural codes for operative fixation. Data collected included number of cases, fracture classification, surgeon seniority, surgical time, and overall time spent in theatre. Results Despite modest population growth in Christchurch (2009: 372,000; 2024: 412,000), PPF cases rose dramatically from 20 in 2009 to 70 in 2024. Corresponding total theatre time increased from 2,877 minutes in 2009 to 12,117 minutes in 2024. Average theatre time per case also rose from 144 to 169 minutes. The growth in operative burden (4.2-fold increase in theatre minutes) was disproportionate to population increase (11%). Discussion The data shows a substantial and accelerating increase in the burden of PPFs. This has implications for theatre capacity, surgical workforce, and hospital resource allocation. Planning must address both increasing demand and the increased complexity of surgery required. These findings highlight the importance of ensuring future employment positions maintain a workforce skilled in complex revision and arthroplasty surgery. Equally, it supports retaining arthroplasty expertise within trauma teams. Conclusion Periprosthetic fractures are rising at a rate far exceeding population growth, placing increased demands on operative services. Planning for additional theatre capacity and senior arthroplasty expertise is critical to meet future demand and maintain timely, safe care for this vulnerable patient group.