JOA - 2026-09-24 - Journal Article
Early Surgical Management of Periprosthetic Hip Fracture Does Not Reduce Mortality or Cardiopulmonary Complications: A Propensity-Matched Analysis.
Papalia AG, Ricotti RG, Frappa N, Alben MG, Ozdag Y, Sutton R
Topics
Key Takeaway
Early surgery (≤2 days) for periprosthetic proximal femur fracture does not reduce 30-day (2.4 vs. 2.5%), 90-day (4.8 vs. 4.4%), or 1-year (7.7 vs. 7.9%) mortality compared to delayed surgery, but is associated with higher 30-day transfusion rates (19.7 vs. 16.4%).
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Summary
This study asked whether operative timing (≤2 vs. >2 days) affects mortality and complications after revision THA for periprosthetic proximal femur fracture, using propensity-score-matched cohorts from a large national database. Mortality at 30, 90, and 365 days was statistically equivalent between groups, as were rates of MI, DVT, PE, pneumonia, AKI, sepsis, SSI, and wound dehiscence. Early surgery was associated with significantly higher transfusion rates at 30 days (19.7 vs. 16.4%, P=0.006) and 90 days (19.9 vs. 17.5%, P=0.045).
Key Limitation
The 2-day cutoff is an administrative construct that conflates all delays beyond 48 hours into a single cohort, obscuring whether outcomes differ at 3, 5, or 7+ days and preventing identification of an optimal surgical window.
Original Abstract
BACKGROUND
Whether early surgery reduces mortality in revision total hip arthroplasty (THA) for periprosthetic proximal femur fractures (PPFF) remains unclear. The aim of this study was to evaluate the association between time to surgery and short- and long-term outcomes following PPFF.
METHODS
Using a large national database, adult patients undergoing revision THA for PPFF were identified. Cohorts were defined by time from diagnosis to surgery: two days versus greater than two days. Propensity score matching (1:1) was performed on demographics and comorbidities, yielding 2,098 patients per cohort. The primary outcome was mortality at 30 days, 90 days, and one year. The secondary outcomes included myocardial infarction (MI), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia (PNA), acute kidney injury (AKI), sepsis, surgical site infection (SSI), wound dehiscence, and transfusion.
RESULTS
The 30-day mortality did not differ between early and delayed cohorts (2.4 versus 2.5%, P = 0.842). Similarly, 90-day mortality (4.8 versus 4.4%) and 1-year mortality (7.7 versus 7.9%) were equivocal. Rates of MI, DVT, PE, PNA, AKI, sepsis, SSI, and wound dehiscence were not significantly different across time windows. However, early surgery was associated with significantly higher transfusion rates at 30 (19.7 versus 16.4%, P = 0.006) and 90 days (19.9 versus 17.5%, P = 0.045).
CONCLUSION
Early operative intervention (two days) for PPFF does not significantly reduce mortality or cardiopulmonary complications compared with delayed surgery (greater than two days). In contrast, early surgery was associated with higher rates of blood transfusion; however, this difference may not be clinically meaningful and should not be interpreted as a reason for unnecessary surgical delay. These findings indicate that delay to surgery beyond two days does not appear to adversely affect short-term mortality or complication rates, allowing additional time for preoperative planning and appropriate allocation of specialized resources.