Abstract
BACKGROUND: Periprosthetic and peri-implant fractures (PPPIFs) are increasingly prevalent due to the rising incidence of joint arthroplasty and fixation procedures. This study investigates 12-month mortality, functional outcomes, and complications associated with PPPIFs, focusing on the impact of the location of primary implant and the management approach. METHODS: A three-year retrospective study was conducted on patients presenting with PPPIFs at a tertiary institution. Primary outcomes included 12-month mortality, while secondary outcomes assessed complication rates, functional recovery (Modified Barthel Index (MBI)) and mobility status. Multivariate analysis was used to identify predictors of mortality and functional outcomes. RESULTS: Among 96 patients (mean age: 82.6 ± 8.1 years, 77.8% female), the 12-month mortality rate was 15.6%, with higher mortality in proximal fractures (17.6%) compared to distal fractures (12.5%). Surgical management was associated with greater functional improvements (mean MBI increase: 41.6 vs. 30.8, p = 0.033) but higher complication rates (35.8% vs. 12.5%, p = 0.030). Multivariate analysis identified the Clinical Frailty Scale as a significant predictor of both mortality (OR = 3.86, p = 0.009) and functional recovery (estimate = -4.72, p = 0.039). CONCLUSION: PPPIFs are associated with considerable 12-month mortality and perioperative complications. Although patients showed marked improvement from immediate post-fracture function, the mean 12-month function remained below pre-fracture levels. Surgical management was associated with greater improvements in functional status and increased perioperative complications. Poorer CFS was found to be negatively associated with both functional and mortality outcomes. Outcomes had no statistically significant difference based on the location of the primary implant.