Consequences of Periprosthetic Fracture After Hemiarthroplasty of the Hip

Introduction Low-energy femoral neck fracture (FNF) in the elderly is a serious injury. For patients with multiple existing comorbidities and frailty, the risk of complications, poor functional outcomes, and premature death may be higher. The treatment aims for immediate weight-bearing, preferably by hemiarthroplasty (HA). Previous research has focused on prosthetic joint infection and dislocation after HA. In this study, we aimed to describe the possible surgical consequences of periprosthetic fracture after HA. Methods HA patients with a periprosthetic fracture occurring between 2009 and 2019 were included in this retrospective cohort study. Patients were identified using local quality registers and systematic searches of the patient administrative system. Results We identified 56 periprosthetic fractures. A total of nine patients (16%) experienced complications related to the fracture. Of these, 42 patients were treated surgically for the periprosthetic fracture, and four patients required additional surgeries. Three of these four reoperated patients underwent two further operations, while one patient had a single reoperation. Within three months after surgery, three patients had died. Seventeen of the 56 patients (30%) required a permanently higher level of care after the periprosthetic fracture, and we observed an increased risk of new long-term care admissions (odds ratio (OR): 2.1; 95% confidence interval (CI): 1.1-4.2; p = 0.04). The 30-day mortality rate was 7%, and the one-year mortality rate was 27%. Most patients were treated surgically for their periprosthetic fractures. Regardless of treatment, 16% of patients experienced surgically related complications. Among the operated patients, 10% required additional surgical procedures. Nearly one-third of patients ultimately needed a permanently higher level of care following the injury. Conclusions In our cohort, we observed a low number of surgical complications, and only a few patients required reoperations. However, about one-third of the patients ultimately required a higher level of care.