Health-Related Quality of Life Following Periprosthetic Femoral Fracture After Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study With Trajectory Analysis

To quantify the impact of periprosthetic femoral fracture (PPF) following total hip arthroplasty (THA) on patient-reported outcome measures (PROMs) compared with the general population norms, and to assess agreement between recalled pre-fracture and prospectively collected PROMs. In this single-centre retrospective cohort study, 106 consecutively treated operatively managed PPF around a THA between 2007 and 2022 were included. EQ-5D-3L, EQ VAS and Oxford Hip Score (OHS) were collected at a median of 3.9 years from PPF. Propensity score matching (1:5) balanced PPF patients with Health Survey for England general population controls by sex, age and deprivation. An agreement cohort with linked arthroplasty database data enabled comparison between prospectively collected one-year post-THA PROMs and recalled pre-fracture PROMs, as well as four-timepoint trajectory analysis (pre-THA, one-year post-THA, pre-fracture recall, and post-PPF). Post-PPF EQ-5D-3L scores were significantly lower than the matched general population (mean difference, MD −0.216, 95% CI −0.287 to −0.145, p<0.001). Almost two-thirds (62.3%, n=66/106) of patients reported clinically meaningful decline compared with the matched general population, with 12.3% (n=13/106) reporting health states worse than death. Subgroup analysis of patients with prospectively collected one-year post-THA and recalled pre-injury PROMs (n=18) showed excellent agreement (EQ-5D-3L, intraclass correlation coefficient 0.894 (95% CI 0.745 to 0.959), with 88.9% (n=16/18) within the minimal important change threshold. Four-timepoint trajectory analysis demonstrated that PPF has a lasting impact on PROMs, with approximately 70% of EQ-5D-3L and 30% of Oxford Hip score benefit erased following PPF. PPF following THA is associated with a clinically meaningful reduction in PROMs in two-thirds of patients, with one-in-eight reporting health states worse than death at 4-years follow-up. PPF erased 70% of the health-related quality-of-life benefit gained from THA. These findings have important implications for patient counselling and targeted prevention strategies.