Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study

Listen to Simon and Amy discuss the paper 'Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study' published in the January 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're delving into the paper 'Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study', published in January 2025 by H J. Aguado and The PIPIPPAS Study Group. I'm Simon and I'm joined by my co-host Amy. 

Hello everyone. I'm looking forward to discussing this topic. The research aims to identify the risk factors associated with one-year mortality in patients with femoral peri-implant fractures. It's an increasingly important area of study due to our aging population.

Aguado and his team conducted this large scale multicentre study known as PIPPAS, which stands for Peri-Implant and PeriProsthetic Survival AnalysiS. The study involved 440 patients [00:01:00] from 56 hospitals in Spain and one in Argentina, all followed for at least one year. 

That represents quite a substantial cohort. The participants were primarily elderly with a median age of 87 years, notably 82.5% of them were female. The study gathered extensive data on demographics, clinical features, fracture characteristics, management strategies and outcomes. 

They assessed frailty using various scales including the Clinical Frailty Scale, and the Pfeiffer score for cognitive impairment. These patients were generally quite frail with a median Clinical Frailty Scale score of six. Many of them resided in nursing homes and had limited mobility. 

It's evident that these patients were not in the best of health initially. Moving onto the results, they observed high mortality rates, 21.6% within one year. Mortality was considerably higher within the [00:02:00] first six months. 

Those figures are quite concerning. The study identified several risk factors for mortality in their univariate and multivariate analyses. Cognitive impairment in a higher age-adjusted Charlson Comorbidity Index were significant indicators of risk. Additionally, patients on antiaggregant or anticoagulant medication upon admission had a doubled risk of mortality. 

One interesting protective factor they discovered was the haemoglobin level at admission. Higher haemoglobin levels seem to offer some protection against mortality. This underscores the importance of addressing anaemia early in the treatment process.

Another fascinating aspect was how management strategies impacted outcomes. Surgical treatment by an experienced surgeon and early mobilization within the first 48 hours were protective factors. Furthermore, retaining the patient's implant without transitioning to arthroplasty when feasible contributed positively.

And we mustn't overlook the role of geriatric [00:03:00] involvement having a geriatrician included in the patient's care improves survival rates. It highlights the necessity of a multidisciplinary approach, especially for frail elderly patients. 

Precisely, Amy. The study emphasizes getting it right the first time. This involves a single operation that allows immediate, unrestricted weightbearing to minimize complications. Such an approach can significantly enhance the patient's quality of life post-surgery. 

Indeed, and it reinforces the main takeaway from the study, early co-management and clinical optimization, particularly for frail older patients are crucial in reducing mortality following these fractures. So to sum up, we've learned that femoral peri-implant fractures have a high one-year mortality rate, especially within the first six months. Key risk factors include cognitive impairment, comorbidity index, and specific medications at admission. Early intervention [00:04:00] strategies, skilled surgical procedures in geriatric care can significantly improve survival outcomes. 

Thank you listeners for joining us today. We hope you found this episode of AI Talks with Bone & Joint insightful. Do stay tuned for our next episode where we will continue exploring the latest research in orthopaedics. Yes. Thank you for listening, everyone. Until next time.