The characteristics and predictors of mortality in periprosthetic fractures around the knee
Nasser, Ahmed A H H Sidhu, Manpreet Prakash, Rohan Mahmood, Ansar Osman, Khabab Chauhan, Govind S Nandra, Rajpal Dewan, Varun Davidson, Jerome Al-Azzawi, Mohammed
Nasser, Ahmed A H H
Sidhu, Manpreet
Prakash, Rohan
Mahmood, Ansar
Osman, Khabab
Chauhan, Govind S
Nandra, Rajpal
Dewan, Varun
Davidson, Jerome
Al-Azzawi, Mohammed
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Affiliation
The Royal Orthopaedic Hospital NHS Foundation Trust; Queen Elizabeth Hospital; St Thomas Hospital; The Whittington Hospital; The Royal Wolverhampton NHS Trust; Walsall Healthcare NHS Trust; Stoke Mandeville Hospital; Sandwell and West Birmingham Hospitals NHS Trust; Princess Royal University Hospital; James Paget Hospital; Addenbrooke's Hospital; Derriford Hospital; University Hospital Coventry & Warwickshire; The Dudley Group NHS Foundation Trust; Royal Devon and Exeter Hospital; Morriston Hospital; Royal United Hospital; St Mary's Hospital; Worthing Hospital; Ealing Hospital; University Hospital Lewisham; Victoria Hospital; Barnet General Hospital; Salford Royal Hospital; Ulster Hospital; Lister Hospital; Yeovil District Hospital; Bristol Royal Infirmary; University of Birmingham
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Publication date
2024-02-01
Subject
Research Projects
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Abstract
Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality.
Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.
Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.
Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.
Citation
Nasser AAHH, Sidhu M, Prakash R, Mahmood A; PPF Study Collaborative; PPF Study Collaborative; Osman K, Chauhan GS, Nandra R, Dewan V, Davidson J, Al-Azzawi M, Smith C, Gawad M, Palaiologos I, Cuthbert R, Wignadasan W, Banks D, Archer J, Odeh A, Moores T, Tahir M, Brooks M, Biring G, Jordan S, Elahi Z, Shaath M, Veettil M, De C, Handford C, Bansal M, Bawa A, Mattar A, Tandra V, Daadipour A, Taha A, Gangoo S, Srinivasan S, Tarisai M, Budair B, Subbaraman K, Khan F, Gomindes A, Samuel A, Kang N, Kapur K, Mainwaring E, Bridgwater H, Lo A, Ahmed U, Khaleeq T, El-Bakoury A, Rashed R, Hosny H, Yarlagadda R, Keenan J, Hamed A, Riemer B, Qureshi A, Gupta V, Waites M, Bleibleh S, Westacott D, Phillips J, East J, Huntley D, Masud S, Mirza Y, Mishra S, Dunlop D, Khalefa M, Balakumar B, Thibbaiah M, Payton O, Berstock J, Deano K, Sarraf KM, Logishetty K, Lee G, Subbiah-Ponniah H, Shah N, Venkatesan A, Cheseldene-Culley J, Ayathamattam J, Tross S, Randhawa S, Mohammed F, Ali R, Bird J, Khan K, Akhtar MA, Brunt A, Roupakiotis P, Subramanian P, Bua N, Hakimi M, Bitar S, Al Najjar M, Radhakrishnan A, Gamble C, James A, Gilmore C, Dawson D, Sofat R, Antar M, Raghu A, Heaton S, Tawfeek W, Charles C, Burnand H, Duffy S, Taylor L, Magill L, Perry R, Pettitt M, Okoth K, Pinkney T. The characteristics and predictors of mortality in periprosthetic fractures around the knee. Bone Joint J. 2024 Feb 1;106-B(2):158-165.
Type
Article