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J Arthroplasty. 2018 Jun;33(6):1914-1918. doi: 10.1016/j.arth.2018.01.046. Epub 2018 Feb 1.

Do Mortality and Complication Rates Differ Between Periprosthetic and Native Hip Fractures?

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Anchorage Fracture and Orthopedic Clinic, Anchorage, AK.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Mt Tam Orthopedics, Larkspur, CA.
Department of Orthopedic Surgery, Loyola University, Maywood, IL.



Epidemiological estimates indicate a rising incidence of periprosthetic hip fractures. While native hip fractures are known to be a highly morbid condition, a significant body of research has led to improved outcomes and decreased complications following these injuries. Comparatively, little research has evaluated the relative morbidity and mortality of periprosthetic hip fractures. The purpose of this study was to compare the morbidity and mortality of periprosthetic vs native hip fractures.


Using the National Surgical Quality Improvement Program (NSQIP) database, 523 periprosthetic hip fractures were matched to native hip fractures using propensity scores. The 30-day rates of complications were compared using McNemar's test. A multivariate regression was then used to determine independent risk factors for mortality following periprosthetic fracture.


Mortality was similar between groups (periprosthetic: 2.7% vs native: 3.4%; P = .49). Periprosthetic fractures exhibited a greater rate of overall (63.1% vs 38.6%; P < .001) and minor complications (59.1% vs 34.4%; P < .001). There was an increased rate of return to the operating room (7.8% vs 3.1%; P < .001) and blood transfusion in the periprosthetic group (54.9% vs 30.2%; P = .001). Age greater than 85 (odds ratio 9.21) and dependent functional status (odds ratio 5.38) were both independent risk factors for mortality following periprosthetic fracture.


While native hip fractures are known to be highly morbid, our findings suggest that periprosthetic hip fractures have a similar mortality with significantly higher short-term morbidity. Future research is warranted to better understand risk factors and prevention strategies for complications in this subset of patients.


NSQIP; complication; mortality; periprosthetic fracture; revision hip

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