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The Burden of Periprosthetic Fractures Following Total Hip and Knee Arthroplasty: Risk Factors, Trends, and Outcomes
Matthew A Peterman1, Jane C Brennan1, Andrea H Johnson2
1Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA.
Insights
Periprosthetic fractures (PPFs) after hip and knee replacements increased by 11% from 2016-2022. Older age, female sex, and comorbidities are key risk factors for these fractures, necessitating targeted prevention strategies.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Public Health
Background:
- Periprosthetic fractures (PPFs) are serious complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- These fractures lead to significant patient morbidity and healthcare costs.
- Understanding PPF trends and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To quantify the incidence and trends of PPFs after THA and TKA in the US.
- To identify patient-specific risk factors associated with PPF development.
- To analyze surgical management trends and outcomes for PPFs.
Main Methods:
- Retrospective analysis of the PearlDiver national database (2016-2022).
- Inclusion of patients undergoing primary unilateral THA or TKA.
- Multivariate and univariate analyses to identify risk factors and compare treatment outcomes (ORIF, revision, revision + ORIF).
Main Results:
- PPF burden increased by approximately 11% for both THA (1.35% to 1.50%) and TKA (0.55% to 0.61%) from 2016-2022.
- Increased age, female sex, and higher comorbidity burden were significant risk factors for PPFs.
- Revision surgery was the most common treatment for THA PPFs, while ORIF and revision were common for TKA PPFs, with high 90-day complication rates across all methods.
Conclusions:
- The incidence of PPFs after THA and TKA showed a non-statistically significant increase of about 11% between 2016 and 2022.
- Targeted prevention strategies for high-risk patients are needed.
- Further research into optimal surgical treatments for PPFs is warranted due to associated high morbidity.
Abstract:
Background Periprosthetic fractures (PPFs) are a significant complication following total hip arthroplasty (THA) and knee arthroplasty (TKA), resulting in substantial patient morbidity. This study aims to quantify the burden of PPF, describe surgical management trends, and identify key patient risk factors in the United States population. Methods A retrospective review of patients undergoing primary unilateral THA or TKA from 2016 to 2022 was performed using the PearlDiver national database. The primary outcome was the burden of PPF in both THA and TKA. Multivariate analyses were performed to identify risk factors for PPF, and univariate analyses were performed to compare outcomes across surgical treatments: open reduction and internal fixation (ORIF), revision, and revision + ORIF combined. Results From 2016 to 2022, the burden of THA PPFs increased from 884 (1.35%) to 1,622 (1.50%), an 11.1% relative increase. The burden of TKA PPFs increased from 669 (0.55%) to 1,147 (0.61%), a 10.9% relative increase. In both populations, increased age, female sex, and higher comorbidity burden were associated with increased risk of PPF. The most common fixation method of PPF after THA was revision, with 2,712 (77.6%) cases, followed by revision + ORIF with 489 (14.0%) cases and ORIF with 295 (8.4%) cases. The most common fixation method of PPF after TKA was revision, with 856 (51.5%) cases, followed by ORIF with 767 (46.2%) cases and revision + ORIF with 38 (2.3%) cases. High 90-day complication rates were observed across treatments. Conclusion The burden of PPFs after THA and TKA increased by approximately 11% from 2016 to 2022, although this did not achieve statistical significance. Targeted strategies for preventing PPFs in high-risk patients and further investigation into optimal treatment methods are warranted, given the high morbidity associated with these injuries.
