Establishing a Core Outcome Set for Post-Operative Periprosthetic Femoral Fractures: Patient and Professional Priorities to Date

Background <br/>Post-operative periprosthetic femoral fractures (POPFF) following hip and knee arthroplasty are the leading cause of implant failure and are associated with high morbidity, mortality, and healthcare costs. However, outcome reporting in the literature is heterogeneous, limiting evidence synthesis and hindering improvements in care. This study aims to develop a Core Outcome Set (COS) for adult patients with POPFF to standardise outcome reporting in future research and audit. <br/><br/>Methods <br/>Candidate outcomes were identified through a systematic review of 616 full-text publications and a secondary thematic analysis of 20 in-depth qualitative interviews with POPFF patients, conducted as part of the Periprosthetic Femoral Fractures – Understanding the Patient Experience and Impact study. Outcomes were categorised using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy and refined through structured discussions with healthcare professionals (via the POPFF Study Management Group, SMG) and patients (via the University of Bristol Patient Experience Partnership in Research, PEP-R). <br/><br/>Results <br/>The systematic review and thematic analysis yielded 62 and 59 outcomes, respectively, which were consolidated into a long-list of 97 unique outcomes. This list was refined by the SMG and PEP-R groups to identify 18 priority outcomes. Patients prioritised life-impact domains such as mobility, emotional well-being, and pain. Clinical outcomes commonly reported in the literature, such as bone union and reoperation, appeared less important to patients. The 18 priority outcomes reflect a multidimensional perspective on recovery after POPFF. <br/><br/>Conclusion <br/>The 18 priority outcomes will be taken forward into a two-round online Delphi survey involving patients, healthcare professionals, and researchers. This will be followed by a final consensus meeting to define the COS. <br/><br/>Implications <br/>This work will produce a patient-informed COS to support consistent and meaningful outcome reporting in future POPFF research and quality improvement initiatives. <br/><br/>Disclosure <br/>Funding was received from Orthopaedic Research UK and the Academy of Medical Sciences.