Abstract
Introduction: The increasing prevalence of osteoporosis, rising numbers of total hip replacements, and longer life expectancy have contributed to a growing incidence of periprosthetic femoral fractures (PPFFs), particularly in elderly, frail, and comorbid populations. In the UK, the Best Practice Tariff (BPT), introduced in 2010, aimed to improve outcomes in neck of femur (NOF) fractures through timely surgery and orthogeriatric care. For NOF fractures, strong, robust evidence links early surgery with better outcomes. Since 2020, the National Hip Fracture Database (NHFD) has included PPFFs; however, evidence regarding the impact of time to surgery (TTS) on PPFF outcomes remains limited. This literature review evaluates whether TTS influences post-operative outcomes in PPFFs
Methods: A literature search was conducted using PubMed, identifying 12 eligible studies on TTS and PPFF outcomes - 11 retrospective cohort studies and 1 systematic review/meta-analysis, published between 2017 and 2024. These studies assessed outcomes including surgical and medical complications, mortality, and length of hospital stay (LOS).
Results: Findings were heterogeneous due to differing TTS definitions and outcome measures. For surgical complications, 67% of studies found no increased risk with shorter TTS. In contrast, 60% linked longer TTS with increased medical complications. Only 20% demonstrated reduced mortality with earlier surgery, unlike consistent findings in NOF fractures. However, 80% found early surgery reduced LOS, and 3 studies associated delays with increased blood transfusion needs.
Conclusion: This literature review highlights the need for more rigorous and standardised research on the effects of TTS in PPFFs. Although the evidence is inconsistent and often low in quality, early surgery in PPFFs appears to lower morbidity and LOS, with limited impact on mortality. There is a pressing need for standardised definitions and outcome measures to support higher-quality research. Establishing national or international databases could facilitate more robust studies and improve care for this high-risk patient group.