Is mortality similar among types of late periprosthetic proximal femoral fractures managed operatively? A retrospective cohort study - 09/11/26

Doi : 10.1016/j.otsr.2026.104985

Marouane Dinia ^a, Yanis Kermad ^a, Karim Bouzid ^a, Jean Baptiste Vincent ^a, Julie Mathieu ^a,^b, Louis Dagneaux ^a,^b,⁎

^a Department of Orthopaedic Surgery, University Hospital of Montpellier, University of Montpellier, 371 av. Gaston Giraud, 34295 Montpellier Cedex 05, France

^b Laboratoire de Mécanique et Génie Civil (LMGC), Univ. of Montpellier, 860 Rue de St-Priest, 34090 Montpellier, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 09 November 2026

Abstract

Introduction

Late periprosthetic proximal femoral fractures (PPFFs) represent an increasing complication with dramatic mortality rates. However, limited data are available stratifying the risk for mortality by fracture types or surgical management. As such, this study aimed to evaluate mortality rates following PPFFs managed operatively, and mortality risk among fracture types according to the Vancouver classification.

Material and Methods

A retrospective study included 124 patients who underwent a late PPFF managed operatively from January 1, 2020 to December 31, 2024 at a single institution. The mean age was 83 ± 10 years, 64% were women. The cohort included 43 B1 fractures (35%) and 28 type C fractures (23%) requiring isolated internal fixation; and 45 Vancouver B2 fractures (36%) and 8 B3 fractures (6%) requiring femoral revision and fixation. The mean surgical delay was 2 to 3 days. The cumulative incidence of deaths was assessed using the Kaplan-Meier method, accounting for competing variables. The adjusted hazard ratios (aHRs) were reported for risk analysis. The mean follow-up was 31 ± 17 months (up to 64 months).

Results

In the overall cohort, 16 out of 124 patients (13%) had died by the time of last follow-up. The early 90-day mortality was 6%, and the cumulative incidence of late mortality ranged from 13% to 22% at one and 5-year, respectively. Cases requiring femoral revision (Vancouver B2 and B3) showed higher mortality risk (aHR = 6.9; p = 0.027) compared to those requiring isolated internal fixation: 23% versus 6% at 1 year, and 27% vs. 15% at 5 years, respectively. Revision for compromised uncemented femoral component (aHR = 3.3; p = 0.049), men (aHR = 3.1; p = 0.036), longer surgical delay (aHR = 1.4; p = 0.039), and older age (aHR = 1.1; p = 0.029) were associated with an increased risk of death.

Conclusion

Mortality rates after late PPFF managed operatively were 6% at 90-day, 13% within the first year and 22% at 5 years in this cohort. While the results of this study do not establish that revision strategy itself increases mortality compared to conservative treatment, they highlight the importance of timely and tailored management of more severe Vancouver fracture patterns, the particularity of non-elective revision setting on frail population, and the role of modern femoral component or cemented fixation in preventing those complications.