Mortality following post-operative periprosthetic fracture of the femur after hip replacement in the last decade: Meta-analysis of 35 cohort studies including 4841 patients

Introduction Post-operative periprosthetic fracture of the femur (POPFF) is associated with increased mortality. There is a lack of general estimates of mortality following POPFF and a need for higher-level evidence in this area. The aim of this study was to estimate mortality following POPFF mortality using data reported in cohort studies from the last decade. Materials and Methods Literature search was conducted using Medline and EMBASE. Primary outcome was all-cause mortality during time as an inpatient, within 30-days, within 90-days and within one year of POPFF. Mortality (95% CI [confidence interval]) was estimated using metaregression. Results 4841 patients from 35 cohort studies were included. Study quality was generally low. Weighted mean follow-up was 2.3 years and the most common POPFF was Vancouver B. Pooled mortality as an inpatient was 2.4% (95% CI 1.6% to 3.4%). Pooled mortality within 30 days was 3.3% (95% CI 2.0% to 5.0%). Pooled mortality within 90 days was 4.8% (95% CI 3.6% to 6.1%). Pooled mortality within one year was 13.4% (95% CI 11.9% to 14.8%). Mortality following POPFF was like that of Neck of femur fracture (NOF) up to 30 days, but better at one year. Conclusion Mortality is like that experienced by patients following NOF up to 30 days, but better at one year, which may represent the lower underlying risk of death in the POPFF cohort. These results may form the basis for evaluation of services treating POPFF in the future