- Design
- Single-centre retrospective cohort, propensity score matched 1:5 with population controls
- Population
- 140 patients with operatively treated periprosthetic femoral fracture after primary THA
- Primary outcome
- EQ-5D-3L, EQ-VAS and Oxford Hip Score at median 2.9 years
- Effect
- EQ-5D mean difference −0.209 (−0.264 to −0.154); 62.9% meaningful deficit
A single-centre cohort studied 140 patients who had surgery for a periprosthetic femoral fracture around a primary total hip arthroplasty (2007–2025). They were matched 1:5 with 700 general-population controls by age, sex and deprivation, and patient-reported outcomes were collected at a median of 2.9 years after fracture.
EQ-5D-3L scores were well below controls (mean difference −0.209, 95% CI −0.264 to −0.154). Nearly two-thirds (62.9%) had a clinically meaningful deficit, and 13 patients (9.3%) reported health states rated worse than death. In 22 patients with scores before and after their arthroplasty and after the fracture, the fracture erased 38.9% of the EQ-5D gain and 36.4% of the Oxford Hip Score gain.
This was retrospective and single-centre, and pre-fracture function relied partly on recall, though recall agreed well with recorded scores. It nonetheless shows that fixation does not restore people to where they were.
The practical change is in how prevention and consent are framed: periprosthetic fracture deserves a place in arthroplasty counselling and in long-term falls and bone health care, not only in the trauma rota.
- Mention periprosthetic fracture and its lasting effect when consenting older patients for hip arthroplasty.
- Build falls and bone health review into arthroplasty follow-up.
- Counsel patients after fixation that recovery may be incomplete.
- Measure patient-reported outcomes after fracture fixation, not only union.
Why it matters
Fixing the fracture is not the same as restoring the patient; prevention carries more of the benefit.
Don't overread it
A single-centre retrospective cohort; the trajectory findings come from only 22 patients.
The statistics, in plain English
An EQ-5D difference of −0.209 is large: the minimal important difference is usually well under 0.1. 'Worse than death' is a defined part of the EQ-5D scale, scored below zero, not a patient's literal statement.
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