Revision for initial periprosthetic femur fracture increases likelihood of subsequent fracture in total hip arthroplasty.

Background: Although a rare complication, periprosthetic fractures (PPF) following total hip arthroplasty (THA) are becoming more common. Revision THA (rTHA) for PPF is associated with high failure rates, and there is a paucity of literature reporting how often there is a subsequent PPF in these patients. This study aimed to determine the rate of femoral re-fracture following rTHA in patients with an initial PPF after primary THA.

Methods: The retrospective study identified 2044 patients who underwent rTHA between 2017 and 2023. Propensity score-matched cohort analysis was conducted to control for demographic variables. The primary outcome was the re-fracture rate and survivability of those patients who were revised for PPF.

Results: There were 183 patients who sustained an initial PPF and underwent subsequent rTHA. Of these patients, five (2.7 %) sustained re-fracture of the femur. After matching, there was a 3.7 % re-fracture rate in patients revised for an initial PPF compared to those who were not revised for PPF (0.37 %,  = 0.017). The 1-year re-fracture-free survivability of patients revised for initial PPF was 95.9 %, which was significantly lower compared to patients revised for non-PPF indications (99.6 %;  = 0.008). Older patients, women, elevated Charlson Comorbidity Index (CCI), and posterior approach during rTHA were found to be risk factors for PPF ( < 0.001).

Conclusion: Patients who were revised for an initial PPF had nearly a 10 times increased risk of re-fracturing compared to patients revised for other indications in THA. However, the similar readmission and failure rates and 1-year implant survivorship suggest comparable outcomes. Further analysis with a larger cohort and more outcome events is necessary.