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Introduction <p>Periprosthetic femoral fractures (PPFs) are an increasing cause of revision total hip arthroplasty (THA) and mainly affect an elderly and frail population. When femoral stem revision is required, surgical management remains associated with substantial morbidity and mortality. However, it remains unclear whether postoperative mortality is primarily driven by patient-related characteristics or by surgery-related factors.</p> Purpose <p>To identify time-dependent prognostic factors for mortality during the first postoperative year following femoral stem revision for PPF.</p> Material and methods <p>A retrospective single-centre consecutive series of 398 PPFs treated with femoral stem revision between January 2011 and August 2023 was analysed. Mean age was 81&#xa0;years (± 11), and 59% of patients had an ASA score ≥ 3. Mortality risk factors were evaluated at 30&#xa0;days, three&#xa0;months, six&#xa0;months, and one&#xa0;year using multivariate analysis.</p> Results <p>One-year mortality was 20.4%. Male sex, older age, and a higher ASA class were independent predictors of mortality at all evaluated postoperative time points. Low BMI emerged as an additional independent predictor of year mortality. Although several clinical and surgical variables were associated with mortality in univariate analyses, only patient-related factors remained independently associated with mortality after multivariable adjustment.</p> Conclusion <p>Mortality following femoral stem revision for PPF remains high in this elderly and vulnerable population. Patient-related factors, particularly older age, higher ASA class, male sex, and low BMI, were the main independent predictors of postoperative mortality, whereas surgical variables were not independently associated with survival after adjustment. These findings highlight the predominant role of baseline patient frailty and may help improve perioperative risk stratification and multidisciplinary management.</p>

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Patient-related rather than surgery-related factors predict mortality following femoral stem revision for periprosthetic femoral fracture: a series of three hundred and ninety eight cases

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • LORENE TALLET,
  • MOHAMMAD ALSUWAIDI,
  • VINCENT HAIGNERE,
  • OLIVIER MARES,
  • NICOLAS CELLIER,
  • PHILIPPE MARCHAND,
  • REMY COULOMB,
  • PASCAL KOUYOUMDJIAN

摘要

Introduction

Periprosthetic femoral fractures (PPFs) are an increasing cause of revision total hip arthroplasty (THA) and mainly affect an elderly and frail population. When femoral stem revision is required, surgical management remains associated with substantial morbidity and mortality. However, it remains unclear whether postoperative mortality is primarily driven by patient-related characteristics or by surgery-related factors.

Purpose

To identify time-dependent prognostic factors for mortality during the first postoperative year following femoral stem revision for PPF.

Material and methods

A retrospective single-centre consecutive series of 398 PPFs treated with femoral stem revision between January 2011 and August 2023 was analysed. Mean age was 81 years (± 11), and 59% of patients had an ASA score ≥ 3. Mortality risk factors were evaluated at 30 days, three months, six months, and one year using multivariate analysis.

Results

One-year mortality was 20.4%. Male sex, older age, and a higher ASA class were independent predictors of mortality at all evaluated postoperative time points. Low BMI emerged as an additional independent predictor of year mortality. Although several clinical and surgical variables were associated with mortality in univariate analyses, only patient-related factors remained independently associated with mortality after multivariable adjustment.

Conclusion

Mortality following femoral stem revision for PPF remains high in this elderly and vulnerable population. Patient-related factors, particularly older age, higher ASA class, male sex, and low BMI, were the main independent predictors of postoperative mortality, whereas surgical variables were not independently associated with survival after adjustment. These findings highlight the predominant role of baseline patient frailty and may help improve perioperative risk stratification and multidisciplinary management.