title: Proximal femoral replacement in the management of acute periprosthetic fractures of the hip: a competing risks survival analysis.
abstract: To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (P=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (P=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation.
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania. Electronic address: matthewcolman@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Colman
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania.
authors.forename: Lisa
authors.initials: L
authors.lastname: Choi
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania.
authors.forename: Antonia
authors.initials: A
authors.lastname: Chen
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Crossett
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania.
authors.forename: Ivan
authors.initials: I
authors.lastname: Tarkin
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: McGough
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation
keywords: periprosthetic fracture; proximal femoral arthroplasty; proximal femur; revision arthroplasty