A cost analysis of treating postoperative periprosthetic femoral fractures following hip replacement surgery in a UK tertiary referral centre

Diagnosis and Treatment Influence Hospital Costs of Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review and meta-analysis aimed to synthesize the hospital costs of revision total hip arthroplasty (rTHA) by periprosthetic joint infection, periprosthetic fracture (PPF), aseptic loosening, and recurrent dislocation diagnoses. In addition, as several surgical options are available within some diagnoses, this study aimed to synthesize the evidence on hospital costs for septic rTHA between debridement, antibiotics, and implant retention and one-stage and two-stage rTHA, and for PPF, the cost between rTHA and open reduction and internal fixation treatment.

METHODS

A systematic search of PubMed, Embase, and Scopus identified all studies reporting the hospital costs of rTHA. Screening, data extraction, and risk of bias assessment were conducted. Hospital costs of each study cohort by main diagnosis and treatment were adjusted to 2024 United States Dollar and pooled using a random-effects model.

RESULTS

Of 866 publications identified, 24 studies were included in the meta-analysis. Mean pooled costs of rTHA for dislocation, aseptic loosening, PPF, and septic rTHA were $25,256, $34,533, $35,904, and $55,707, respectively. The mean cost of septic rTHA (16 study cohorts) at $57,264 was 87% higher than aseptic rTHA (22 cohorts) at $30,224. A two-stage septic rTHA ($70,311) cost 77% more than one-stage septic rTHAs ($39,676). The cost of rTHA for PPF ($35,904) was 26% more than open reduction and internal fixation for PPF ($28,410).

CONCLUSIONS

The cost of rTHA is progressively higher by diagnosis in the order of dislocation, aseptic loosening, PPF, and infection. Future studies should separately report rTHA costs by diagnosis and treatment type and longitudinally examine the hospital costs of this patient cohort, particularly for septic cases, beyond initial treatment to better understand the burden of rTHA.

Effect of insurance type on Management of Vancouver B Periprosthetic Fractures: length of stay, discharge destination and cost implications

BACKGROUND

To assess the effect of private versus public insurance on hospital length of stay, discharge destination, and costs in managing Vancouver B periprosthetic femoral fractures (PFF).

METHODS

A retrospective cohort study of PFF patients operatively managed at five public trauma centers. The primary outcome was hospital length of stay. Secondary outcomes included discharge destination and costs related to implants and hospital beds.

RESULTS

The study included 195 PFF cases (133 public, 62 private). Private patients had lower ASA scores (2.8 versus 3.1, P = 0.006) and were more likely to come from independent residences (87% versus 74%, P = 0.045). Private patients spent 8 fewer days in the hospital (12 ± 8 versus 20 ± 19 days, P < 0.001) and were more often discharged to rehabilitation (74% versus 48%, P = 0.003). Public hospital costs were higher for public patients ($37 456 versus $25 324, P = 0.005), largely due to longer stays. Implant costs were similar between private and public patients, but patients that underwent revision surgeries increased costs significantly compared to patients that underwent open reduction and internal fixation alone ($6257 versus $3511, P < 0.001).

CONCLUSION

Private insurance was linked to shorter hospital stays and increased discharge to rehabilitation. Public PPF patients incur an average cost of $37 456 for public hospitals, compared to $25 324 for private patients. Delays in public patient rehabilitation access may prolong hospital stays, suggesting a need for alternative care pathways, such as PPF tailored home-based rehabilitation and support programs.

Risk factors for periprosthetic femoral fracture risk around a cemented polished taper-slip stem using an osteoporotic composite bone model

This biomechanical study aimed to determine if variations in stem material, stem geometry, stem offset and cement viscosity affect mechanical resistance to postoperative periprosthetic fracture (PFF) after hip arthroplasty with a commonly used cemented polished taper-slip (PTS) stem (CPT, Zimmer Biomet) in a novel osteoporotic composite femoral bone model. Thirty-six osteoporotic composite femoral models were tested using a standardised in-vitro loading technique to simulate a typical PFF. Outcome measures were torque to failure (N), fracture energy (N/m2) and rotation to failure (°). Comparisons were made by stem material (cobalt chrome vs stainless steel), stem geometry (CPT stem vs Exeter stem), stem offset (standard offset vs extra extended offset) and cement viscosity (high viscosity vs low viscosity). Statistical comparisons were carried out with significance set at p < 0.05. All tested samples produced clinically representative fracture patterns with varying degrees of bone and cement comminution. There was no statistically significant difference in torque to failure, fracture energy or rotation to failure between any of the compared variables (all p > 0.05). This is the first biomechanical study on mechanical resistance to PFF using osteoporotic composite bone models. For the CPT stem, it confirms that stem material, stem offset, stem geometry and cement viscosity do not affect mechanical resistance to PFF in an osteoporotic bone model.

Cemented femoral stem design and postoperative periprosthetic fracture risk following total hip arthroplasty

Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented femoral stem design on the risk of PFF.