Treatment and outcomes of periprosthetic femoral fractures in patients aged 90 years or older - a retrospective bicentre cohort study with 107 patients.

purposeThe surgical treatment of periprosthetic femoral fractures (PFFs) is highly demanding, especially in very old patients. For patients aged 90 years or older, data regarding internal fixation (IF) and revision arthroplasty (RA) are lacking.

methodsThis retrospective case series was conducted in two different regional centres in one country. We enrolled patients with an age of 90 years or older, and who had PFFs with cemented or cementless standard stems. The treatment period was from 01/2010 to 12/2024. The exclusion criteria were interprosthetic femoral fractures or periprosthetic acetabular fractures. Treatment was performed with IF (locking plates) or RA (noncemented revision stems). The primary end point was any revision within the follow-up period. The secondary end points were death, serious adverse events, and function with Parker score. The minimum follow-up for living patients was one year after surgery. Living patients received a final contact by phone.

resultsA total of 107 patients were included in this study. The mean age of the cohort was 92.0 years (range 90 to 100), and most patients were female (n = 85). Following the Vancouver classification and its recommendations, 17 out of 22 patients with type B1 fractures were treated with IF, 44 out of 48 patients with type B2/3 fractures were treated with RA, and 34 out of 37 patients with type C fractures were treated with IF. Twelve patients (11.2%) received IF instead of RA or vice versa concerning the Vancouver classification and according to the surgeons’ individual decision. IF was superior to RA with respect to time to surgery (p < 0.01), duration of surgery (p < 0.001), estimated blood loss (p < 0.001), and length of hospital stay (p = 0.017). Revision rates, serious adverse events, and mortality rates did not exhibit significant differences between the two groups. The mean Kaplan–Meier survial rate for the cohort was 29.1 ± 3.2 months. The mean Parker score at the time of follow-up was 4.1 points for 14 living patients.

conclusionPatients aged 90 years or older who undergo surgical treatment for PFF benefit from surgery and obtain similar outcomes regarding IF and RA which is determined by the fracture types of the Vancouver classification. Recommendations according to the classification are also useful for nonagenarian or frail patients, but without academic doctrine. The revision rate observed in this context was low.