@article{ref1, title="The characteristics and predictors of mortality in periprosthetic fractures around the knee", journal="Bone and joint journal", year="2024", author="Nasser, Ahmed A. H. H. and Sidhu, Manpreet and Prakash, Rohan and Mahmood, Ansar and Osman, Khabab and Chauhan, Govind S. and Nandra, Rajpal and Dewan, Varun and Davidson, Jerome and Al-Azzawi, Mohammed and Smith, Christian and Gawad, Mothana and Palaiologos, Ioannis and Cuthbert, Rory and Wignadasan, Warran and Banks, Daniel and Archer, James and Odeh, Abdulrahman and Moores, Thomas and Tahir, Muaaz and Brooks, Margaret and Biring, Gurdeep and Jordan, Stevan and Elahi, Zain and Shaath, Mohammed and Veettil, Manoj and De, Chiranjit and Handford, Charles and Bansal, Mohit and Bawa, Akshdeep and Mattar, Ahmed and Tandra, Varun and Daadipour, Audrina and Taha, Ahmed and Gangoo, Shafat and Srinivasan, Sriram and Tarisai, Mandishona and Budair, Basil and Subbaraman, Krishna and Khan, Farrukh and Gomindes, Austin and Samuel, Arjun and Kang, Niel and Kapur, Karan and Mainwaring, Elizabeth and Bridgwater, Hannah and Lo, Andre and Ahmed, Usman and Khaleeq, Tahir and El-Bakoury, Ahmed and Rashed, Ramy and Hosny, Hazem and Yarlagadda, Rathan and Keenan, Jonathan and Hamed, Ahmed and Riemer, Bryan and Qureshi, Arham and Gupta, Vatsal and Waites, Matthew and Bleibleh, Sabri and Westacott, David and Phillips, Jonathan and East, Jamie and Huntley, Daniel and Masud, Saqib and Mirza, Yusuf and Mishra, Sandeep and Dunlop, David and Khalefa, Mohamed and Balakumar, Balasubramanian and Thibbaiah, Mahesh and Payton, Olivia and Berstock, James and Deano, Krisna and Sarraf, Khaled M. and Logishetty, Kartik and Lee, George and Subbiah-Ponniah, Hariharan and Shah, Nirav and Venkatesan, Aakaash and Cheseldene-Culley, James and Ayathamattam, Joseph and Tross, Samantha and Randhawa, Sukhwinder and Mohammed, Faisal and Ali, Ramla and Bird, Jonathan and Khan, Kursheed and Akhtar, Muhammad A. and Brunt, Andrew and Roupakiotis, Panagiotis and Subramanian, Padmanabhan and Bua, Nelson and Hakimi, Mounir and Bitar, Samer and Al Najjar, Majed and Radhakrishnan, Ajay and Gamble, Charlie and James, Andrew and Gilmore, Catherine and Dawson, Dan and Sofat, Rajesh and Antar, Mohamed and Raghu, Aashish and Heaton, Sam and Tawfeek, Waleed and Charles, Christerlyn and Burnand, Henry and Duffy, Sean and Taylor, Luke and Magill, Laura and Perry, Rita and Pettitt, Michala and Okoth, Kelvin and Pinkney, Thomas", volume="106-B", number="2", pages="158-165", abstract="AIMS: 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.

Language: en

", language="en", issn="2049-4394", doi="10.1302/0301-620X.106B2.BJJ-2023-0700.R1", url="http://dx.doi.org/10.1302/0301-620X.106B2.BJJ-2023-0700.R1" }