Frailty and femoral periprosthetic fractures around the hip: outcomes in nonagenarians.

OBJECTIVE

To present the clinical outcomes of patients above 90 years of age admitted with periprosthetic fractures around hip.

METHODS

This was a retrospective study, of prospectively collected data, including patients treated at a single institution during 2014 to 2024. Data were assessed for fractures type, mode of treatment, time to surgery, length of stay, post-op complications, discharge destination, reoperation, and 30-day and 12-month mortality.

RESULTS

There were 51 patients admitted during the study period. Mean age was 93.7 years. All were walking either independently or with support prior to their admission. Fractures were classified according to the unified classification system with type B1 (n = 23), and type C (n = 13) fractures were the most common fractures. Thirty patients underwent ORIF, five revision arthroplasty, and remaining patients were managed conservatively. Median time to surgery was 2 days. Overall, more than half of patients experienced post-op complications (n = 26). The reoperation rate was 5.7%. The median length of stay was 14 days. Twenty-two patients were discharged home, while 20 were discharged to residential care. Mean Charlson Comorbidity Index (CCI) was 5.78. Thirty-day mortality was 17.6%, and 12-month mortality was 45%. CCI of 5 or above was associated with higher 1-year mortality (p = 0.02).

CONCLUSION

We observed a significantly higher rate of post-op complications and mortality rate. Surgical stabilization / revision arthroplasty and early unrestricted weight bearing helps in reducing complications. We recommend prioritizing the management of these patients and initiating early mobilization to minimize the risk of complications and mortality.