A periprosthetic femoral fracture may undo a third of what the hip replacement gave

The edition in brief

A single-centre propensity-matched cohort of 140 patients who had surgery for a periprosthetic femoral fracture after primary total hip arthroplasty found EQ-5D-3L scores well below matched population controls at a median of 2.9 years (mean difference −0.209). Almost two-thirds had a clinically meaningful deficit and 9.3% reported health states worse than death. In a trajectory subgroup, the fracture erased about 39% of the EQ-5D gain and 36% of the Oxford Hip Score gain from the original arthroplasty. Prevention and counselling, not only fixation, carry the weight. A meta-analysis of 18 studies (202,847 participants) estimated insomnia in 42% of people with knee, hip or hand osteoarthritis, with sleep apnoea and restless legs also common, though at very low certainty. A meta-analysis of 21 randomised trials (1,790 patients) found platelet-rich plasma gave small advantages over hyaluronic acid in WOMAC scores and in pain at 12 months, but not at 3 or 6 months, with substantial heterogeneity and risk of bias. The pearl covers bone health and falls review after hip arthroplasty in older patients.