000168271 001__ 168271
000168271 005__ 20260130164313.0
000168271 0247_ $$2doi$$a10.1302/2633-1462.61.BJO-2024-0113.R1
000168271 0248_ $$2sideral$$a147767
000168271 037__ $$aART-2025-147767
000168271 041__ $$aeng
000168271 100__ $$aAguado, Héctor J.
000168271 245__ $$aRisk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study
000168271 260__ $$c2025
000168271 5060_ $$aAccess copy available to the general public$$fUnrestricted
000168271 5203_ $$aAimsThe Peri-Implant and PeriProsthetic Survival AnalysiS (PIPPAS) study aimed to investigate the risk factors for one-year mortality of femoral peri-implant fractures (FPIFs).MethodsThis prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III.ResultsOverall, 90.5% (n = 398) of the patients were treated surgically, 57.0% (n = 227) retained the implant, and 88.7% (n = 353) managed with fixation. Mortality rates were 8.2% (n = 3.6) in-hospital, 11.4% (n = 50) at 30 days, 21.1% (n = 93) at six months, and 21.6% (n = 95) at 12 months. Medical complications, mainly delirium, were common in the acute setting (52.7%, n = 215). The nonunion rate was 4.1% (n = 18). Mortality risk factors in the univariate analysis were age, living at a nursing home, no walking outdoors, frailty variables, fractures in the distal epiphysis, fractures around a proximal nail, discharge to a healthcare facility, and no osteoporotic treatment at discharge. Protective factors against mortality in the univariate analysis were surgical treatment by an experienced surgeon, management without an arthroplasty, allowing full weightbearing, mobilization in the first 48 hours postoperatively, and geriatric involvement. Risk factors for mortality in the multivariate analysis were cognitive impairment (Pfeiffer’s questionnaire) (hazard ratio (HR) 1.14 (95% CI 1.05 to 1.23), p = 0.002), age-adjusted CCI (HR 1.18 (95% CI 1.07 to 1.30), p = 0.001), and antiaggregant or anticoagulant medication at admission (HR 2.00 (95% CI 1.19 to 3.38), p = 0.009). Haemoglobin level at admission was protective against mortality (HR 0.85 (95% CI 0.74 to 0.97), p = 0.018).ConclusionMortality in FPIFs occurs mainly within the first six months of follow-up. Early co-management and clinical optimization, particularly targeting frail older patients, is crucial in reducing mortality following these fractures.Cite this article: Bone Jt Open 2024;6(1):43–52.
000168271 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000168271 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000168271 700__ $$0(orcid)0000-0001-7441-8731$$aRoche Albero, Adrián$$uUniversidad de Zaragoza
000168271 7102_ $$11013$$2830$$aUniversidad de Zaragoza$$bDpto. Cirugía$$cÁrea Traumatología y Ortopedia
000168271 773__ $$g6, 1 (2025), 43-52$$tBone & joint open$$x2633-1462
000168271 8564_ $$s872935$$uhttps://zaguan.unizar.es/record/168271/files/texto_completo.pdf$$yVersión publicada
000168271 8564_ $$s2269741$$uhttps://zaguan.unizar.es/record/168271/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000168271 909CO $$ooai:zaguan.unizar.es:168271$$particulos$$pdriver
000168271 951__ $$a2026-01-30-14:51:22
000168271 980__ $$aARTICLE