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Background <p>Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2–B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2–B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty.</p> Materials and methods <p>PIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2–B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon’s discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis.</p> Results <p>Out of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, <i>p</i> &lt; 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, <i>p</i> = 0.003) but higher 1-year mortality (25% versus 14.3%, <i>p</i> = 0.04). There were no differences in medical or surgical complications (<i>p</i> = 0.83 and <i>p</i> = 0.36) at any time, but dislocation rate was higher in the revision group (<i>p</i> = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group (<i>p</i> = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors.</p> Conclusions <p>Revision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2–B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2–B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing.</p> <p>Level of Evidence II: prospective cohort study.</p> <p>Trial registration: ClinicalTrials.gov (NCT04663893)</p> Graphical Abstract <p></p>

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Internal fixation versus revision arthroplasty for Vancouver B2–B3 fractures: mortality and functional outcomes in frail patients. Insights from the PIPPAS study of 485 patients

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  • 发表日期：

    2025年12月22日

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  • Jesús Moreta,
  • Héctor J. Aguado,
  • Pablo Castillón-Bernal,
  • Josep M. Muñoz-Vives,
  • Pilar Camacho,
  • Montsant Jornet-Gibert,
  • Jordi Teixidor,
  • Adela Pereda-Manso,
  • Yaiza García-Sánchez,
  • Cristina Ojeda-Thies,
  • Pablo García-Portabella,
  • Elvira Mateos Álvarez,
  • David Noriega-González,
  • María-Fe Muñoz-Moreno,
  • Irene Arroyo-Hernantes,
  • Begoña Aránzazu Álvarez-Ramos,
  • Belén García-Medrano,
  • Carmen Martínez-Sellés,
  • Sergio Marín-Jiménez,
  • Virginia García-Virto,
  • Sergio País-Ortega,
  • Adriana Acha,
  • Jordi Tomás-Hernández,
  • Jordi Selga-Marsà,
  • José Vicente Andrés-Peiró,
  • Carlos Piedra-Calle,
  • Ferrán Blasco-Casado,
  • Ernesto Guerra-Farfán,
  • Jordi Querolt-Coll,
  • Guillermo Triana-López de Santamaría,
  • José M. Hernández,
  • Marina Renau-Cerrillo,
  • Carles Gil-Aliberas,
  • Anna Carreras-Castañer,
  • Marian Vives-Barquiel,
  • Eliam Ajuria Fernández,
  • Eugenia Fernández Manzano,
  • Unai García De Cortázar,
  • Mirentxu Arrieta,
  • Daniel Escobar,
  • Estíbaliz Castrillo,
  • Patricia Balvis Balvis,
  • Maciej Denisiuk,
  • Manuel Castro Menéndez,
  • Sonsoles Pastor,
  • Ane Larrazábal,
  • Beatriz Olías-López,
  • Patricia Amaya-Espinosa,
  • Juan Boluda-Mengod,
  • David González-Martín,
  • Daniel López-Dorado,
  • Juan Carlos Borrás-Cebrián,
  • Carles Martínez-Pérez,
  • Patricio Andrés Freile Pazmiño,
  • Pablo Calavia-Calé,
  • Miguel Ángel Suárez-Suárez,
  • Lucía Lanuza-Lagunilla,
  • Antonio García Arias,
  • Julián Cabria-Fernández,
  • Javier García-Coiradas,
  • José Valle-Cruz,
  • Jaime Sánchez del Saz,
  • Jesús Mora-Fernández,
  • Pedro Lalueza-Andreu,
  • César Bonome-Roel,
  • María Ángeles Cano-Leira,
  • Antonio Benjumea Carrasco,
  • Ana López-de Pariza,
  • Alexis Fernández-Juan,
  • Carmen Sevillano-de la Puente,
  • Miren Juldain-Mondragón,
  • Jorge Guadilla Arsuaga,
  • Eladio Saura-Sánchez,
  • Sandra Giménez-Ibáñez,
  • Plácido Sánchez-Gómez,
  • F. Javier Ricón-Recarey,
  • Elena M. García García,
  • Francisco Cuadrado-Abajo,
  • María Isabel Pérez-Núñez,
  • Pedro del Pozo-Manrique,
  • Francisco Manuel García Navas-García,
  • Ester García-Paredero,
  • Ainhoa Guijarro-Valtueña,
  • Teresa Beteta Robles,
  • Inés Navas-Pernía,
  • Ignasi De Villasante-Jirón,
  • Teresa Serra Porta,
  • Carmen Carrasco Becerra,
  • Víctor Otero-Naveiro,
  • Silvia Pena Paz,
  • Inés Fernández-Billón Castrillo,
  • Fátima Fernández-Dorado,
  • Amaia Martínez-Menduiña,
  • Víctor Vaquerizo-García,
  • Antonio Murcia-Asensio,
  • Elena Galián-Muñoz,
  • Carmelo Marín-Martínez,
  • Adrián Muñoz-Vicente,
  • Nuria Plaza-Salazar,
  • Carla Gámez-Asunción,
  • Jennifer Benito-Santamaría,
  • Paula Salgado-Tarrida,
  • Oriol Prats-Puente,
  • Alejandro Cuenca-Copete,
  • Blas González-Montero,
  • Luis Alejandro Giraldo-Vegas,
  • Juan Mingo-Robinet,
  • Ricardo Briso-Montiano,
  • Amaya Barbería-Biurrun,
  • Emma Escudero-Martínez,
  • Laura Chouza-Montero,
  • María Naharro-Tobío,
  • Alfons Gasset-Teixidor,
  • Andrea Domínguez-Ibarrola,
  • J. M. Peñalver,
  • Jorge Serrano-Sanz,
  • Adrián Roche-Albero,
  • Carlos Martín-Hernández,
  • María Macho-Mier,
  • José Carlos Saló-Cuenca,
  • Jordi Espona Roselló,
  • Guillermo Criado-Albillos,
  • Hugo Gabriel Cabello-Benavides,
  • David Alonso Nestar,
  • Jerónimo González-Bernal,
  • Josefa González-Santos,
  • Jorge Cunchillos-Pascual,
  • Jorge Martínez-Íñiguez Blasco,
  • José Manuel Bogallo-Dorado,
  • Alicia Ramírez-Roldán,
  • Juan Ramón Cano-Porras,
  • Fernando Marqués-López,
  • Santos Martínez-Díaz,
  • Pablo I. Slullitel,
  • Guido S. Carabelli,
  • Ignacio Astore,
  • Bruno Rafael Boietti,
  • Julio César Córdova-Peralta,
  • Carlos Hernández-Pascual,
  • Alfredo Rodríguez-Gangoso,
  • Iván Dot-Pascuet,
  • Ana Piñeiro-Borrero,
  • José María Pérez-Sánchez,
  • Alfonso Mandía-Martínez,
  • Julio De Caso-Rodríguez,
  • Jordi Martín-Marcuello,
  • Miguel Benito-Mateo,
  • Oiane Alda-Gastiain,
  • Irene Corcuera-Elosegui,
  • María Rosa González-Panisello,
  • Nicolás Elizalde Pérez-Salazar,
  • María De Sande-Díaz

摘要

Background

Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2–B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2–B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty.

Materials and methods

PIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2–B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon’s discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis.

Results

Out of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, p < 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, p = 0.003) but higher 1-year mortality (25% versus 14.3%, p = 0.04). There were no differences in medical or surgical complications (p = 0.83 and p = 0.36) at any time, but dislocation rate was higher in the revision group (p = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group (p = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors.

Conclusions

Revision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2–B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2–B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing.

Level of Evidence II: prospective cohort study.

Trial registration: ClinicalTrials.gov (NCT04663893)

Graphical Abstract