Identifying risk factors for one-year mortality after surgical treatment of periprosthetic femoral fractures around hip arthroplasty

Background: The increasing number of hip arthroplasties (HA) worldwide, including hemi- and total hip arthroplasties, has led to a rise in periprosthetic femoral fractures (PPFF). These fractures are technically complex, linked to high morbidity and mortality, and impose a burden on healthcare systems. However, clinical guidelines for managing PPFF are lacking, and data on factors affecting postoperative outcomes remain limited. This study aimed to identify risk factors for one-year mortality in surgically treated PPFF patients. Methods: A retrospective single-center cohort study was conducted on patients with surgically treated PPFF. Data on patient-, implant-, fracture-, surgical- and perioperative characteristics were collected. Univariate and multivariable logistic regression analyses were used to identify independent predictors of one-year mortality. Results: Among 157 patients (median age was 83 years, 59.2 % ASA III), the one-year overall mortality rate was 16.6 %. Multivariable analyses suggested that residency in a nursing home [OR 4.1 (95 %CI 1.20–14.25) p = 0.025], use of a walking aid [OR 3.6 (95 %CI 1.07–12.36) p = 0.039], initial uncemented stem fixation [OR 4.08 (95 %CI 1.25–13.35) p = 0.020], preoperative urinary bladder catheter (UBC) [OR 4.5 (95 %CI 1.33–15.25) p = 0.016] and lower Body Mass Index (BMI) (Kg/m2) [OR 0.87 (95 %CI 0.75–1.00) p = 0.049) were independently associated with one-year mortality. Conclusion: PPFF patients are frail and highly comorbid. Risk factors such as low BMI, nursing home residency, walking aid use, uncemented stem fixation, and preoperative UBC highlight the need for targeted strategies to improve outcomes.