J Knee Surg 2013; 26(01): 027-030
DOI: 10.1055/s-0033-1333905
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Mortality after Periprosthetic Femur Fractures

Philipp Nicolas Streubel
1   Department of Orthopedic Surgery, Mayo Clinic, Owatonna, Minnesota
› Author Affiliations
Further Information

Publication History

31 October 2012

13 December 2012

Publication Date:
07 February 2013 (online)


Periprosthetic femur fractures are becoming more frequent, as the prevalence of hip and knee arthroplasties keeps increasing and our population continues to age. Although the vast majority of literature on periprosthetic fractures has centered on radiographic and functional outcomes, only limited information is available on mortality. Patients with periprosthetic femur fractures are at a similar or higher mortality risk than hip fracture patients. Furthermore, periprosthetic femur fractures carry a significantly higher mortality risk than hip or knee arthroplasty or operative fixation of native distal femur fractures. Advanced patient age and underlying comorbidities increase the risk of mortality. Factors related to the injury itself and treatment method may play an additional role, especially during the short postoperative period.

  • References

  • 1 Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 2008; 466 (7) 1652-1656
  • 2 Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am 1999; 30 (2) 183-190
  • 3 Fredin HO, Lindberg H, Carlsson AS. Femoral fracture following hip arthroplasty. Acta Orthop Scand 1987; 58 (1) 20-22
  • 4 Garcia-Cimbrelo E, Munuera L, Gil-Garay E. Femoral shaft fractures after cemented total hip arthroplasty. Int Orthop 1992; 16 (1) 97-100
  • 5 Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 1998; 47: 243-249
  • 6 Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011; 25 (Suppl. 02) S66-S70
  • 7 Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011; 93 (1) 96-101
  • 8 Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res 2006; 446: 167-175
  • 9 Merkel KD, Johnson Jr EW. Supracondylar fracture of the femur after total knee arthroplasty. J Bone Joint Surg Am 1986; 68 (1) 29-43
  • 10 Ritter MA, Faris PM, Keating EM. Anterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty. J Arthroplasty 1988; 3 (2) 185-187
  • 11 Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 2008; 90 (9) 2000-2012
  • 12 Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 2006; 88 (6) 1215-1222
  • 13 Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 1992; 23 (2) 249-257
  • 14 Morrey BF, Kavanagh BF. Complications with revision of the femoral component of total hip arthroplasty. Comparison between cemented and uncemented techniques. J Arthroplasty 1992; 7 (1) 71-79
  • 15 Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 2006; 443: 266-272
  • 16 Jain NB, Higgins LD, Ozumba D , et al. Trends in epidemiology of knee arthroplasty in the United States, 1990-2000. Arthritis Rheum 2005; 52 (12) 3928-3933
  • 17 Bhattacharyya T, Chang D, Meigs JB, Estok II DM, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am 2007; 89 (12) 2658-2662
  • 18 McLauchlan GJ, Robinson CM, Singer BR, Christie J. Results of an operative policy in the treatment of periprosthetic femoral fracture. J Orthop Trauma 1997; 11 (3) 170-179
  • 19 Tsiridis E, Narvani AA, Haddad FS, Timperley JA, Gie GA. Impaction femoral allografting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg Br 2004; 86 (8) 1124-1132
  • 20 Buttaro MA, Farfalli G, Paredes Núñez M, Comba F, Piccaluga F. Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am 2007; 89 (9) 1964-1969
  • 21 de Ridder VA, de Lange S, Koomen AR, Heatley FW. Partridge osteosynthesis: a prospective clinical study on the use of nylon cerclage bands and plates in the treatment of periprosthetic femoral shaft fractures. J Orthop Trauma 2001; 15 (1) 61-65
  • 22 Cain PR, Rubash HE, Wissinger HA, McClain EJ. Periprosthetic femoral fractures following total knee arthroplasty. Clin Orthop Relat Res 1986; (208) 205-214
  • 23 Cordeiro EN, Costa RC, Carazzato JG, Silva JdosS. Periprosthetic fractures in patients with total knee arthroplasties. Clin Orthop Relat Res 1990; (252) 182-189
  • 24 Ebraheim NA, Gomez C, Ramineni SK, Liu J. Fixation of periprosthetic femoral shaft fractures adjacent to a well-fixed femoral stem with reversed distal femoral locking plate. J Trauma 2009; 66 (4) 1152-1157
  • 25 Fink B, Grossmann A, Singer J. Hip revision arthroplasty in periprosthetic fractures of Vancouver type B2 and B3. J Orthop Trauma 2012; 26 (4) 206-211
  • 26 O'Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br 2005; 87 (12) 1617-1621
  • 27 Ricci WM, Bolhofner BR, Loftus T, Cox C, Mitchell S, Borrelli Jr J. Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Joint Surg Am 2005; 87 (10) 2240-2245
  • 28 Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res 2011; 469 (4) 1188-1196
  • 29 Baker DM. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1997; 79 (3) 470
  • 30 Bhandari M. Does early surgical repair of hip fractures improve patient outcomes?. CMAJ 2004; 171 (2) 130
  • 31 Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ 2006; 332 (7547) 947-951
  • 32 Parvizi J, Rapuri VR, Purtill JJ, Sharkey PF, Rothman RH, Hozack WJ. Treatment protocol for proximal femoral periprosthetic fractures. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 8-16
  • 33 Klein GR, Parvizi J, Rapuri V , et al. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am 2005; 87 (8) 1777-1781
  • 34 Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am 2002; 84-A (6) 945-950
  • 35 Singh JA, Sperling JW, Cofield RH. Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008. BMC Musculoskelet Disord 2011; 12: 231
  • 36 Berry DJ. Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem. Clin Orthop Relat Res 2003; (417) 224-231
  • 37 Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br 2009; 91 (11) 1424-1430
  • 38 Langenhan R, Trobisch P, Ricart P, Probst A. Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modular prosthesis nail. J Orthop Trauma 2012; 26 (2) 80-85
  • 39 Lindahl H, Oden A, Garellick G, Malchau H. The excess mortality due to periprosthetic femur fracture. A study from the Swedish national hip arthroplasty register. Bone 2007; 40 (5) 1294-1298
  • 40 Young SW, Walker CG, Pitto RP. Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 2008; 79 (4) 483-488
  • 41 Anakwe RE, Aitken SA, Khan LA. Osteoporotic periprosthetic fractures of the femur in elderly patients: outcome after fixation with the LISS plate. Injury 2008; 39 (10) 1191-1197
  • 42 Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am 2003; 85-A (11) 2156-2162
  • 43 Maury AC, Pressman A, Cayen B, Zalzal P, Backstein D, Gross A. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am 2006; 88 (5) 953-958
  • 44 Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 2005; 87 (8) 1123-1126
  • 45 Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality After Distal Femur Fractures in Elderly Patients. Clin Orthop Relat Res 2010; (Sep) 10
  • 46 Nieves JW, Bilezikian JP, Lane JM , et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int 2009; (May) 30
  • 47 Christodoulou A, Terzidis I, Ploumis A, Metsovitis S, Koukoulidis A, Toptsis C. Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods. Arch Orthop Trauma Surg 2005; 125 (2) 73-79
  • 48 Boyd Jr AD, Wilber JH. Patterns and complications of femur fractures below the hip in patients over 65 years of age. J Orthop Trauma 1992; 6 (2) 167-174
  • 49 Dunlop DG, Brenkel IJ. The supracondylar intramedullary nail in elderly patients with distal femoral fractures. Injury 1999; 30 (7) 475-484
  • 50 Kolb W, Guhlmann H, Windisch C, Marx F, Koller H, Kolb K. Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma 2010; 69 (3) 670-676