Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip
Nasser, Ahmed A H H Osman, Khabab Chauhan, Govind S Prakash, Rohan Handford, Charles Nandra, Rajpal S Mahmood, Ansar Riemer, Bryan Qureshi, Arham Gupta, Vatsal
Nasser, Ahmed A H H
Osman, Khabab
Chauhan, Govind S
Prakash, Rohan
Handford, Charles
Nandra, Rajpal S
Mahmood, Ansar
Riemer, Bryan
Qureshi, Arham
Gupta, Vatsal
Abstract
Aims: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade.
Methods: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade.
Results: A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture.
Conclusion: The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes.
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Date
2023-09-01
Type
Article
Subject
Orthopaedics
Citation
Nasser AAHH, Osman K, Chauhan GS, Prakash R, Handford C, Nandra RS, Mahmood A; PPF Study Collaborative. Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip. Bone Jt Open. 2023 Sep 1;4(9):659-667.
Journal / Source Title
Bone & Joint Open
DOI
10.1302/2633-1462.49.BJO-2023-0065.R1
PMID
37654129
Publisher
British Editorial Society of Bone and Joint Surgery