Periprosthetic femur fractures of the hip in elderly patients: early surgery reduces operative time, hospitalization, and mortality.

INTRODUCTION

Periprosthetic femur fractures around the hip represent a significant clinical challenge, particularly in patients aged 65 and older, as delayed treatment can lead to increased morbidity and mortality. Early surgical intervention is generally recommended to minimize complications and optimize functional recovery. This study aims to assess the impact of surgical timing on operative duration, hospitalization length, complication rates, and long-term survival in elderly patients with periprosthetic femur fractures.

METHODS

A retrospective observational study followed STROBE guidelines and the Declaration of Helsinki. Patients aged ≥ 65 years with periprosthetic femur fractures treated surgically between 2014 and 2022 were included. Patients were stratified into two groups based on surgical timing: Early Surgery (< 24 h) and Delayed Surgery (≥ 24 h). Frailty was assessed using the Clinical Frailty Scale, while medical condition severity was evaluated with the National Early Warning Score. Primary outcomes included operative time, hospitalization length, complications, and survival. Statistical analyses were performed using t-tests, chi-squared tests, and Kaplan-Meier survival analysis, with significance at p < 0.05.

RESULTS

Seventy-two patients were analyzed. The mean operative time was significantly shorter in the Early Surgery group (145 ± 49.6 min) compared to the Delayed Surgery group (176 ± 71.9 min; p < 0.001). Hospitalization duration was also reduced in the Early Surgery group (12.1 ± 5.98 days vs. 19.7 ± 13.2 days; p = 0.002). Survival analysis demonstrated significantly better long-term outcomes in the Early Surgery group (p = 0.036), with 10-year survival rates of 92.8% versus 68.2%.

CONCLUSION

Early surgical intervention (< 24 h) in elderly patients with periprosthetic femur fractures is associated with shorter operative time, reduced hospitalization, and improved long-term survival compared to delayed surgery. Prompt surgical management should be prioritized to enhance patient outcomes.