Health-related quality of life following periprosthetic femoral fracture after total hip arthroplasty

Aims: The aim of this study was to quantify the impact of a postoperative periprosthetic femoral fracture following a primary total hip arthroplasty (THA) on patient-reported outcome measures (PROMs) compared with normal values in the general population, and to assess the agreement between recalled pre-fracture and prospectively collected PROMs. Methods: This single-centre retrospective cohort study involved 140 operatively managed patients with a periprosthetic femoral fracture which was sustained around a primary THA, between 2007 and 2025, with a minimum follow-up of one year. The EQ-5D-3L, EQ-VAS, and Oxford Hip Score (OHS) were collected at a median of 2.9 years (IQR 1.9 to 5.5) after the fracture. Complete case propensity score matching (1:5) balanced patients who had a periprosthetic fracture with Health Survey for England general population controls (n = 700) by sex, age, and deprivation. An agreement cohort with data from a linked arthroplasty database enabled comparison between prospectively collected PROMs one year after THA and recalled pre-fracture PROMs, as well as the analysis of PROMs at four timepoints (before THA, one year after THA, pre-fracture recall, and after the periprosthetic femoral fracture). Results: The mean EQ-5D-3L scores after periprosthetic femoral fracture were significantly lower than those in the matched general population (mean difference -0.209 (95% CI -0.264 to -0.154); p < 0.001). Almost two-thirds of patients (62.9%; n = 88) reported a clinically meaningful decrease compared with the general population, with 9.3% (n = 13/140) reporting health states which were worse than death. Subgroup analysis of patients with prospectively collected one-year post-THA and recalled pre-injury PROMs (n = 22) showed good agreement (EQ-5D-3L, intraclass correlation coefficient 0.884 (95% CI 0.746 to 0.950)), with 77.3% (n = 17) being within the minimal important change threshold. Analysis of the trajectory at the four timepoints showed that a periprosthetic femoral fracture had a lasting impact on PROMs, with 38.9% of EQ-5D-3L and 36.4% of the benefit in the OHS being erased following the fracture. Conclusion: A periprosthetic femoral fracture following primary THA was associated with a clinically meaningful reduction in PROMs in about two-thirds of patients, with one-in-ten reporting health states worse than death, at a median follow-up of about three years. These findings have important implications when counselling patients and for targeted strategies designed to prevent a periprosthetic femoral fracture.