Risk Factors and Predictors of 1-Year Mortality in 262 Vancouver Type C Periprosthetic Femoral Fractures: Insights from the PIPPAS Prospective Multicenter Observational Study.

Background/

Objectives

Vancouver type C periprosthetic femoral fractures (VC-PFFs) predominantly affect frail elderly patients and are associated with high mortality, yet limited evidence exists regarding prognostic factors. The PIPPAS study (Peri-Implant and PeriProsthetic Survival Analysis) sub-analysis aimed to investigate the risk factors for one-year mortality following VC-PFF and identify predictors of medical and surgical complications.

Methods

This prospective, multicenter, observational case series was conducted across 59 hospitals in Spain and involved 262 VC-PFF patients between January 2021 and April 2023 with a minimum 1-year follow-up. Demographic, clinical, management, and surgical and outcome data were collected. Logistic regression models were used to identify predictors of one-year mortality and complications.

Results

One-year mortality was 30.1%. VC-PFF patients were elderly (median age 85 years, IQR (12.75)), female (77.1%) and frail: median clinical frailty scale 5, IQR (2), mild cognitive impairment (median Pfeiffer score 3, IQR (5)), and multiple comorbidities (median age-adjusted Charlson comorbidity index (a-CCI) 6, IQR (2)). Surgery was performed in 94.7% of cases, primarily with plate osteosynthesis (62.3%) or intramedullary nailing (29.1%). Male sex, higher age, frailty, cognitive impairment, ASA score, and a-CCI were significantly associated with increased mortality. Protective factors included higher hemoglobin levels, surgical treatment, and early postoperative ambulation. No significant difference in mortality was observed between fixation techniques.

Conclusions

One-year mortality in VC-PFF patients is high. These findings underscore the need for individualized treatment plans and reinforce the role of early co-management and clinical optimization.