Alarmingly High Rates of Complications and Refracture Among Patients with Early Periprosthetic Femoral Fracture Within 30 Days After THA

BACKGROUND: The purpose of this study was to compare the outcomes of patients who underwent a total hip arthroplasty (THA) and sustained a postoperative periprosthetic femoral fracture either within the early postoperative period, within 30 days, or at later time points. METHODS: A large, all-payer national database was queried to identify patients who underwent a primary THA between 2010 and 2022. Patients who underwent a primary THA and sustained a periprosthetic femoral fracture within 30 days postoperatively were propensity-score matched on the basis of age, sex, and comorbidity burden to 3 separate cohorts based on timing: fracture between 31 and 90 days postoperatively (n = 1,725), fracture between 91 days and 1 year (n = 1,887), and no fracture within 1 year (n = 4,465). The 30-day fracture group had a mean age of 66.63 ± 10.15 years, and 75% of patients in this group were female. Regression analyses were utilized to evaluate outcomes at 90 days and 2 years. Survivorship analyses utilizing death as a competing end-point were conducted for rates of infection, refracture, and reoperation at up to 2 years. RESULTS: Patients who sustained a periprosthetic femoral fracture within 30 days after primary THA demonstrated significantly greater rates of complications within 90 days relative to each comparison cohort. The 2-year survivorships free of refracture and reoperation were significantly lower (p < 0.05) for the early fracture cohort relative to matched patients who sustained a fracture at other time points. Additionally, 2-year survivorships were poorer in the ≤30-day cohort than in the comparison cohort who had not sustained a fracture within 1 year postoperatively: survivorships free of infection (87.8% [95% confidence interval (CI), 86.8% to 88.8%] compared with 97.7% [95% CI, 97.3% to 98.1%]), refracture (57.4% [95% CI, 56.0% to 58.9%] compared with 99.5% [95% CI, 99.3% to 99.7%]), and reoperation (48.5% [95% CI, 47.1% to 50.0%] compared with 97.6% [95% CI, 97.2% to 98.1%]) were all significantly lower (p < 0.05). CONCLUSIONS: Patients who sustained an early periprosthetic femoral fracture within 30 days following primary THA were at significantly greater risk for complications than patients who sustained a periprosthetic femoral fracture at later time points. The exceedingly high rates of complications compared with patients without a periprosthetic femoral fracture stresses the importance of not only prevention but potential interventions both perioperatively and postoperatively in an attempt to mitigate the risk of complications for these at-risk patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.