The characteristics and predictors of mortality in periprosthetic fractures around the knee

dc.citation.epageBone Joint J. 2024 Feb 1;106-B(2):158-165. doi: 10.1302/0301-620X.106B2.BJJ-2023-0700.R1.
dc.citation.issue2
dc.citation.spage158-165
dc.citation.volume106-b
dc.contributor.authorNasser, Aahh
dc.contributor.authorSidhu, M.
dc.contributor.authorPrakash, R.
dc.contributor.authorMahmood, A.
dc.contributor.authorOsman, K.
dc.contributor.authorChauhan, G. S.
dc.contributor.authorNandra, R.
dc.contributor.authorDewan, V.
dc.contributor.authorDavidson, J.
dc.contributor.authorAl-Azzawi, M.
dc.contributor.authorSmith, C.
dc.contributor.authorGawad, M.
dc.contributor.authorPalaiologos, I.
dc.contributor.authorCuthbert, R.
dc.contributor.authorWignadasan, W.
dc.contributor.authorBanks, D.
dc.contributor.authorArcher, J.
dc.contributor.authorOdeh, A.
dc.contributor.authorMoores, T.
dc.contributor.authorTahir, M.
dc.contributor.authorBrooks, M.
dc.contributor.authorBiring, G.
dc.contributor.authorJordan, S.
dc.contributor.authorElahi, Z.
dc.contributor.authorShaath, M.
dc.contributor.authorVeettil, M.
dc.contributor.authorDe, C.
dc.contributor.authorHandford, C.
dc.contributor.authorBansal, M.
dc.contributor.authorBawa, A.
dc.contributor.authorMattar, A.
dc.contributor.authorTandra, V.
dc.contributor.authorDaadipour, A.
dc.contributor.authorTaha, A.
dc.contributor.authorGangoo, S.
dc.contributor.authorSrinivasan, S.
dc.contributor.authorTarisai, M.
dc.contributor.authorBudair, B.
dc.contributor.authorSubbaraman, K.
dc.contributor.authorKhan, F.
dc.contributor.authorGomindes, A.
dc.contributor.authorSamuel, A.
dc.contributor.authorKang, N.
dc.contributor.authorKapur, K.
dc.contributor.authorMainwaring, E.
dc.contributor.authorBridgwater, H.
dc.contributor.authorLo, A.
dc.contributor.authorAhmed, U.
dc.contributor.authorKhaleeq, T.
dc.contributor.authorEl-Bakoury, A.
dc.contributor.authorRashed, R.
dc.contributor.authorHosny, H.
dc.contributor.authorYarlagadda, R.
dc.contributor.authorKeenan, J.
dc.contributor.authorHamed, A.
dc.contributor.authorRiemer, B.
dc.contributor.authorQureshi, A.
dc.contributor.authorGupta, V.
dc.contributor.authorWaites, M.
dc.contributor.authorBleibleh, S.
dc.contributor.authorWestacott, D.
dc.contributor.authorPhillips, J.
dc.contributor.authorEast, J.
dc.contributor.authorHuntley, D.
dc.contributor.authorMasud, S.
dc.contributor.authorMirza, Y.
dc.contributor.authorMishra, S.
dc.contributor.authorDunlop, D.
dc.contributor.authorKhalefa, M.
dc.contributor.authorBalakumar, B.
dc.contributor.authorThibbaiah, M.
dc.contributor.authorPayton, O.
dc.contributor.authorBerstock, J.
dc.contributor.authorDeano, K.
dc.contributor.authorSarraf, K. M.
dc.contributor.authorLogishetty, K.
dc.contributor.authorLee, G.
dc.contributor.authorSubbiah-Ponniah, H.
dc.contributor.authorShah, N.
dc.contributor.authorVenkatesan, A.
dc.contributor.authorCheseldene-Culley, J.
dc.contributor.authorAyathamattam, J.
dc.contributor.authorTross, S.
dc.contributor.authorRandhawa, S.
dc.contributor.authorMohammed, F.
dc.contributor.authorAli, R.
dc.contributor.authorBird, J.
dc.contributor.authorKhan, K.
dc.contributor.authorAkhtar, M. A.
dc.contributor.authorBrunt, A.
dc.contributor.authorRoupakiotis, P.
dc.contributor.authorSubramanian, P.
dc.contributor.authorBua, N.
dc.contributor.authorHakimi, M.
dc.contributor.authorBitar, S.
dc.contributor.authorAl Najjar, M.
dc.contributor.authorRadhakrishnan, A.
dc.contributor.authorGamble, C.
dc.contributor.authorJames, A.
dc.contributor.authorGilmore, C.
dc.contributor.authorDawson, D.
dc.contributor.authorSofat, R.
dc.contributor.authorAntar, M.
dc.contributor.authorRaghu, A.
dc.contributor.authorHeaton, S.
dc.contributor.authorTawfeek, W.
dc.contributor.authorCharles, C.
dc.contributor.authorBurnand, H.
dc.contributor.authorDuffy, S.
dc.contributor.authorTaylor, L.
dc.contributor.authorMagill, L.
dc.contributor.authorPerry, R.
dc.contributor.authorPettitt, M.
dc.contributor.authorOkoth, K.
dc.contributor.authorPinkney, T.
dc.date.accessioned2024-04-22T14:05:54Z
dc.date.available2024-04-22T14:05:54Z
dc.date.epub2024-03-01
dc.date.issued2024-02-01
dc.description.abstractAIMS: 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.
dc.description.admin-note0
dc.description.noteNot held
dc.identifier.citationNasser A, Sidhu M, Prakash R, Mahmood A, Osman K, Chauhan GS, et al. The characteristics and predictors of mortality in periprosthetic fractures around the knee. The bone & joint journal. 2024;106-b(2):158-65.
dc.identifier.doi10.1302/0301-620x.106b2.Bjj-2023-0700.R1
dc.identifier.journalThe bone & joint journal
dc.identifier.pmid38425310
dc.identifier.urihttps://hdl.handle.net/11287/623216
dc.language.isoeng
dc.publisherBritish Editorial Society of Bone and Joint Journal
dc.relation.urlhttps://boneandjoint.org.uk/article/10.1302/0301-620X.106B2.BJJ-2023-0700.R1
dc.rights© 2024 The British Editorial Society of Bone & Joint Surgery.
dc.subjectAdult
dc.subjectHumans
dc.subject*Periprosthetic Fractures/etiology
dc.subjectKnee Joint/surgery
dc.subjectKnee/surgery
dc.subject*Arthroplasty, Replacement, Knee/adverse effects
dc.subject*Femoral Fractures/surgery
dc.subject*Rheumatic Diseases/etiology/surgery
dc.subjectRetrospective Studies
dc.subjectReoperation
dc.titleThe characteristics and predictors of mortality in periprosthetic fractures around the knee
dc.typeJournal Article
dc.type.versionepublish
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