Müller Katharina, Zeynalova Samira, Fakler Johannes K M, Kleber Christian, Roth Andreas, Osterhoff Georg
Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany.
Int Orthop. 2025 Jan;49(1):211-217. doi: 10.1007/s00264-024-06346-7. Epub 2024 Oct 10.
Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it.
Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality.
One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18 h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002).
Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation.
IV (Retrospective cohort study).
髋部周围骨折是脆弱性的一个指标，与高死亡率和各种并发症相关。髋部周围骨折的一种特殊类型是全髋关节置换术（THA）后股骨假体周围骨折（PPF）。本研究的目的是调查THA后PPF相关的死亡率，并确定可能增加死亡率的危险因素。
确定2010年至2020年在我们大学医院接受THA后PPF治疗的连续患者（N = 158），并使用居民登记处评估死亡率。进行单因素（Kaplan-Meier估计器）和多因素（Cox回归）统计分析以确定影响死亡率的危险因素。
1年死亡率为23.4%，2年死亡率为29.2%。死亡率受年龄、性别、治疗、合并症类型和手术时间的显著影响（p < 0.05）。与随叫随到手术相比，正常工作时间（8至18小时）进行手术可使死亡率降低53.2%（OR：0.468，95% CI 0.223，0.986；p = 0.046）。每增加一岁，死亡风险增加12.9%（OR：1.129，95% CI 1.078，1.182；p < 0.001）。根据温哥华分类的骨折类型对死亡率没有影响（p = 0.179）。与翻修关节成形术相比，钢板固定和保守治疗与更高的死亡率相关（钢板：OR 2.8，95% CI 1.318，5.998；p = 0.007；保守：OR 2.5，95% CI 1.421，4.507；p = 0.002）。
与这些时间以外的手术相比，正常工作时间进行手术与较低的死亡率相关。在这个回顾性队列中，手术时间对全因死亡率没有显著影响，翻修关节成形术与比保守治疗或钢板固定更低的死亡率相关。
IV（回顾性队列研究）。
