Dislocation is associated with increased mortality following revision total hip arthroplasty for periprosthetic hip fractures

Introduction: Prevalence of periprosthetic fractures (PPFs) is continuously increasing. This study aimed to: (1) report on outcomes following revision THA (r-THA) for PPFs; (2) identify factors associated with mortality; and (3) report on the performance of modular tapered fluted stems (MFTs) as the revision stem-type of choice. Methods: This is a retrospective, consecutive case series of all femoral PPFs treated with r-THA at an academic, tertiary-referral centre between 2008 and 2023. Patients managed solely with open reduction internal fixation (ORIF) were excluded. Demographic and clinical data were collected from electronic medical records. Radiographic analysis was used to assess canal filling ratio, fracture union, stem subsidence, stability and survivorship. Primary outcomes measured included reoperations and mortality as well as stem survivorship free of re-revision at latest follow-up. Results: 96 patients/hips satisfied criteria (mean age: 76 years; 62% female). Most (83%) underwent rTHA for Vancouver B2 fractures. Dislocation post rTHA was detected in 10% of patients. 29% of patients required reoperation. Mortality rates at 30 days and 1 year were 4% and 10%, respectively. Patient- (higher Charlson Comorbidity Index [CCI] 1.70 ± 1.49 vs. 0.80 ± 1.57, p = 0.02) and surgical- (dislocation post-rTHA – 30%, [OR 4.8] p = 0.03) factors were associated with 1-year mortality. MFTs ( n = 83) demonstrated a 2-year and 5-year all-cause re-revision survivorships of 95.2% (95% CI, 87.9–99.7) and 94.0% (95% CI, 79.0–97.0), respectively. Conclusions: Postoperative mortality following rTHA for PPF is associated with patient and surgical factors. While we did not establish a causal relationship, as dislocation is associated with increased mortality, surgeons should strongly consider the use of dual-mobility or constrained liner bearings at revision when conversion of acetabular bearing surface is possible. MFTs are a reliable option when used during rTHA for an indication of PPF.