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Risk for hip fracture before and after total knee replacement in Sweden.
C H Vala1,2, J Kärrholm3, J A Kanis4,5
1Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden. cecilie.hongslo.vala@gu.se.
Summary
Total knee replacement (TKR) patients face a low hip fracture risk before surgery but an increased risk in the first year after TKR, particularly for trochanteric fractures and individuals under 75.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Epidemiology
Background:
- Osteoarthritis is linked to higher bone density, prompting investigation into fracture risk.
- Total knee replacement (TKR) is a common procedure for osteoarthritis, necessitating an understanding of associated risks.
Purpose of the Study:
- To assess hip fracture risk before and after total knee replacement (TKR).
- To analyze risks for specific hip fracture types (femoral neck, trochanteric).
- To examine fracture risk variations across genders and age groups post-TKR.
Main Methods:
- A population-based cohort study in Sweden (1987-2002) involving over 4.2 million individuals.
- Identification of TKR patients (n=39,291) and hip fracture cases (n=195,860) from national registers.
- Utilized Poisson regression models for risk time analyses.
Main Results:
- Hip fracture risk was slightly reduced before TKR (HR=0.86) but significantly increased in the first year after (HR=1.26).
- Increased risk observed for trochanteric fractures (HR=1.13) and in individuals aged 50-74 (HR=1.28) post-TKR.
- Femoral neck fracture risk remained similar to the baseline population (HR=0.95).
Conclusions:
- Patients experience a low hip fracture risk pre-TKR, with a notable increase in the first year post-surgery.
- Elevated risks for trochanteric fractures and younger patients (under 75) persist after TKR.
- Potential contributing factors include altered knee biomechanics, physical activity changes, and fall risk.
