Early surgery did not lower short-term mortality after periprosthetic hip fracture

The edition in brief

A target trial emulation using Japanese administrative data on 4564 patients with periprosthetic hip fracture (mean age 84) compared a strategy of surgery within two days of admission with surgery on days 3 to 10. Neither 30-day mortality (1.72% vs 0.83%; RR 2.06, 95% CI 0.64 to 3.73) nor 90-day mortality (2.35% vs 2.31%; RR 1.01, 0.59 to 1.68) differed clearly, so the 48-hour target for native hip fractures may not carry the same mortality benefit here. Complications and function were not studied, so avoidable delay is not justified. In a three-centre Chinese trial of 240 patients with Kellgren-Lawrence grade I–II knee osteoarthritis, a standardised PRP pathway (patient selection, leukocyte-poor PRP, ultrasound guidance and structured rehabilitation) improved 12-month pain and function more than conventional PRP care, with fewer adverse events, but had no placebo arm and cannot show PRP itself works. A meta-analysis of 18 retrospective studies (1441 patients) found anterior fixation of ankylosing spondylitis cervical fractures was associated with more complications than posterior fixation (OR 2.97), with no differences in neurological recovery or mortality. The pearl covers imaging the whole spine after minor trauma in ankylosing spondylitis.