HEALTH-RELATED QUALITY OF LIFE FOLLOWING PERIPROSTHETIC FEMORAL FRACTURE AFTER TOTAL HIP ARTHROPLASTY: A PROPENSITY SCORE-MATCHED COHORT STUDY WITH TRAJECTORY ANALYSIS

Abstract

To quantify the impact of postoperative periprosthetic femoral fracture (POPFF) after total hip arthroplasty (THA) on patient-reported outcome measures (PROMs) relative to general population norms, and to validate recalled pre-fracture PROMs. Single-centre retrospective cohort study of 140 patients with an operatively managed POPFF around a primary THA between 2007 and 2025, with minimum one-year follow-up. EQ-5D-3L, EQ VAS and Oxford Hip Score (OHS) were collected at a median of 2.9 years (IQR 1.9 to 5.5) after POPFF. Complete-case propensity score matching (1:5) to Health Survey for England controls (n=700) balanced age, sex and deprivation. In patients with linked arthroplasty registry data, recalled pre-fracture PROMs were compared with prospectively collected one-year post-THA scores, and a four-timepoint recovery trajectory was constructed. EQ-5D-3L was significantly lower after POPFF than in the matched general population (mean difference −0.209, 95% CI −0.264 to −0.154, p<0.001). Almost two-thirds (62.9%, 88/140) reported a clinically meaningful deficit and 9.3% (13/140) a health state worse than death. Recalled pre-fracture PROMs agreed well with prospectively collected scores (n=22; EQ-5D-3L intraclass correlation coefficient 0.884, 95% CI 0.746 to 0.950), 77.3% (17/22) within the minimal important change. Trajectory analysis showed 38.9% of the EQ-5D-3L and 36.4% of the OHS gain from THA was erased by POPFF. POPFF after THA is associated with a clinically meaningful reduction in PROMs in two-thirds of patients, with one in ten reporting a health state worse than death at a median of three years. These findings should inform patient counselling and prevention strategies.