Risk Stratification in Periprosthetic Hip Fracture Surgery: The Risk Analysis Index Is Superior to the Five-Item Modified Frailty Index for Predicting 30-Day Complications.
Document Type
Article
Publication Title
The Journal of arthroplasty
Abstract
BACKGROUND: Periprosthetic femoral fractures account for up to 16% of all revision total hip arthroplasties with one- and two-year mortality rates of 23.4 and 29.2%, respectively. Given the substantial clinical and financial burden, accurate preoperative risk assessment is essential. This study evaluated the predictive performance of the Five-Item Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI) in patients undergoing surgery for PFs, aiming to improve preoperative assessment, inform surgical decision-making, and facilitate postoperative planning.
METHODS: A total of 824 patients at least 18 years old who underwent revision total hip arthroplasty and/or open reduction internal fixation for periprosthetic femoral fractures were identified in a national surgical database. The RAI and mFI-5 were calculated for each patient. Outcomes were major and minor complications, readmission, reoperation, nonhome discharge, wound complications, venous thromboembolisms, and mortalities. Multivariable logistic regression models for each index-outcome were fitted, controlling for body mass index, operative time, procedure type, and smoking status. The ability of RAI and mFI-5 to predict postoperative outcomes was assessed using the area under the receiver operating curve (AUC) with DeLong's test used to compare differences between correlated AUCs.
RESULTS: The RAI demonstrated significantly better predictive ability for mortality (AUC: 0.69 versus 0.53; P = 0.033) and nonhome discharge (AUC: 0.71 versus 0.57; P < 0.001) compared with mFI-5. In adjusted models, RAI was significantly associated with mortality (odds ratio: 1.08; 95% confidence interval: 1.00 to 1.17; P = 0.040) and nonhome discharge (odds ratio: 1.16; 95% confidence interval: 1.12 to 1.20; P < 0.001).
CONCLUSIONS: The RAI was superior to the mFI-5 in predicting mortality and nonhome discharge for patients undergoing surgical management of PPFs. Our findings support the implementation of RAI as a tool for preoperative risk stratification and may be impactful in surgical planning and counseling of geriatric orthopaedic patients and their families.
DOI
10.1016/j.arth.2026.06.043
Publication Date
6-24-2026
Recommended Citation
Jowkar N, Ruffner M, Koltenyuk V, Sokolik ID, Horsley H, Rohl M, Williamson TK, Weick JW. Risk Stratification in Periprosthetic Hip Fracture Surgery: The Risk Analysis Index Is Superior to the Five-Item Modified Frailty Index for Predicting 30-Day Complications. J Arthroplasty. 2026 Jun 24:S0883-5403(26)00664-9. doi: 10.1016/j.arth.2026.06.043. Epub ahead of print. PMID: 42341960.