Reported Outcomes for Patients Following Post-operative Periprosthetic Femoral Fractures (POPFF)- a Systematic Review

Aims
Post-operative periprosthetic femoral fracture (POPFF) is an increasingly common and morbid complication of arthroplasty. This review aims to determine what outcomes are reported for POPFF and how they are measured, to inform the development of a core outcome set.

Methods
Systematic searches of major databases and clinical trial registries (June 2014 to May 2024) identified studies reporting outcomes for greater than five POPFF patients in English or Chinese. Multiple reviewers performed study screening and data extraction. Outcomes were extracted verbatim, collapsed into outcome domain subcategories, and categorised. Outcomes were synthesised descriptively, with subgroup exploration by implant (hip/knee) and economic setting. Registration: PROSPERO CRDXXXXXX.

Results
A total of 564 studies, including 119,445 POPFF patients (mean age 75.0 years; 61.8% female), were included. Across studies, 2,711 individual reported outcomes were collapsed into 671 unique terms within 59 outcome domain subcategories. Outcome reporting was dominated by the physiological/clinical core area (38.7%), followed by life impact (29.3%), resource use (12.8%), adverse events (11.7%), and death (7.6%). The most frequently reported subcategories were bone union/healing, surgical complications, component/prosthesis outcomes, hip function, and mortality/survival. Only 46.4% of outcomes were accompanied by a clear definition or named outcome measurement instrument (OMI); for bone union, just 7.4% provided a clear definition, 44.9% were vague, and 47.7% provided none. Health-related quality of life (HRQoL) was measured in 6.9% of studies (39 instances) using seven instruments, most commonly SF-12/36 and EQ-5D. Patterns varied between hip and knee POPFF and between high-income and low- to middle-income settings; one-year mortality was the most frequently reported survival time point.

Conclusion
Outcome reporting after POPFF is heterogeneous, clinician-centred, and frequently undefined, with sparse use of PROMs and HRQoL instruments. These findings support the development of a POPFF core outcome set and recommended OMIs to standardise reporting and promote patient-centred research.