The clinical and economic burden of proximal femur periprosthetic fractures



The number of hip replacements is constantly and progressively increasing, resulting in an increase in periprosthetic fractures. The main aim of this study is to analyze costs and outcomes of surgical treatment for those fractures.

Materials and methods

A retrospective study was performed on periprosthetic proximal femur fracture presented a single-level I trauma center. Medical records were reviewed in terms of demographic data, diagnosis (according to Vancouver classification), type of surgical treatment, hospitalization length and follow-up. Patients were interviewed about number of consultations after discharge, medications and physiotherapy sessions. Clinical outcome was evaluated with WOMAC score at the last follow-up, and patient health status was evaluated with the EQ5D5L score pre-trauma and at the last follow-up. Patients were divided into two groups according to surgical treatment: reduction and internal fixation alone and revision plus fixation. A further group was also considered: patients underwent a Girdlestone procedure. Global costs for each group were calculated.


We initially recruited 117 patients, 17 of them were lost at follow-up. Furthermore, 19 patients (19%) died during the follow-up, and 81 of them were therefore included in the study. Mean follow-up was 26.5 months. Mean postoperative WOMAC score was 39.44, and EQ5D5L score was 9.12 for the preoperative period and 12.35 at the last follow-up. A significant worsening of clinical conditions was found comparing the period before fracture to the last follow-up (p < 0.01). Quality of life after surgery resulted to be poor or fair in 40% of the patients at a mean follow-up of 26.5 months. No significant differences between groups were found according to patients' health status. Mean global costs for mayor surgeries were 18,822 Euros; mean costs for fixation alone were 17,298 Euros while for fixation and revision were 20,966 Euros, but no statistically difference was found between these two groups. Mean cost for Girdlestone group was 12,664 Euros.


In proximal femur periprosthetic fractures, either fixation or revision plus fixation presents high costs but patients’ postoperative quality of life is poor.

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Fig. 1

Data availability

Data are available on the server of University of Turin.


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Azienda Ospedaliero Universitaria Città della Salute e della Scienza.

Author information




Aprato A was involved in study conception and design, bibliography analysis, manuscript writing and revision, supervision. Tosto F, Comba A and Piccato A collected and analyzed the data; Daghino W, Mellano D and Massè A were involved in manuscript conception, wrote the manuscript and contributed with important scientific knowledge giving the final approval.

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Correspondence to A. Aprato.

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All authors declare that they have no conflict of interest.

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This study was approved by the Institutional Review Board (IRB) of Azienda Ospedaliero Universitaria Città della Salute e della Scienza, and the protocols used in the study were approved by the local ethical committee.

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All patients agreed for publication.

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Aprato, A., Tosto, F., Comba, A. et al. The clinical and economic burden of proximal femur periprosthetic fractures. Musculoskelet Surg (2021).

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  • Hip fractures
  • Periprosthetic fractures
  • Femur fractures
  • Clinical results
  • Costs
  • Life quality