Complications and Mortality of Open Reduction and Internal Fixation for Periprosthetic Femoral Fractures Around Cementless Femoral Stems: A Mid- to Long- Term Retrospective Cohort Study

Background/Objectives: The optimal treatment strategy for periprosthetic femoral fractures (PFFs) around cementless femoral stems remains controversial, particularly for fractures in which stem stability is difficult to determine preoperatively. While revision arthroplasty is often recommended for unstable stems, open reduction and internal fixation (ORIF) continues to be widely used in clinical practice. This study aimed to evaluate mid- to long-term clinical outcomes, complications, and mortality of ORIF for PFFs around cementless stems. Methods: We retrospectively reviewed patients who underwent ORIF for PFFs around cementless femoral stems at a single tertiary referral center between March 2002 and March 2021. Clinical and radiographic outcomes, complications, reoperation, and mortality were assessed. Kaplan–Meier survival analysis was performed to estimate the survival rates for being free of revision and reoperation. Results: A total of 53 patients were included, with a mean follow-up of 4.4 years (range, 1.0 to 19.6). The mean age was 71.0 years, and 30 patients (56.6%) were female. Most fractures were Vancouver type B1 (84.9%). Radiographic union was achieved in 51 patients (96.2%), with a mean time to union of 20.5 weeks. The estimated revision-free survival was 98.1% (95% CI, 87.4–99.7%), and the reoperation-free survival rate was 94.3% (95% CI, 83.5–98.1%) at 5 years. The one- and five-year mortality rates were 5.7% and 22.6%, respectively. Conclusions: Open reduction and internal fixation for PFFs around cementless stems demonstrated acceptable mid- to long-term outcomes with comparable survivorship in selected patients. Although reoperations were not uncommon, mortality rates were comparable. ORIF may represent a reasonable treatment option in carefully selected patients, particularly those with high surgical risk. However, as the cohort was predominantly composed of B1 fractures, the findings should be interpreted primarily in the context of this fracture subtype.