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Published on: December 3, 2017
Rising Volume of Periprosthetic Fractures After Primary Total Hip and Knee Arthroplasty: A Contemporary Epidemiologic
Kevin Y Heo1, Max McCall1, Nigam Sheth1
1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Background:
Periprosthetic fractures following total hip arthroplasty and total knee arthroplasty are complications associated with substantial morbidity and mortality. As the volume of primary arthroplasty continues to increase in the United States, the incidence and overall burden of periprosthetic fractures are expected to rise accordingly. However, contemporary trends and future projections in emergency department (ED) visits and operative management for these injuries remain incompletely characterized.
Methods:
There were three national databases that were queried to identify the national volume of ED visits for periprosthetic hip and knee fractures between 2017 and 2022, as well as to capture inpatient and outpatient surgical management for these fractures during the same period, including fixation, arthroplasty, or combination procedures. Patients who presented with periprosthetic joint infections were excluded. National surgical volumes were calculated, and future projections through 2035 were modeled using linear and Poisson regression.
Results:
Between 2017 and 2022, 224,456 patients presented to the ED with periprosthetic hip and knee fractures, of whom 155,335 underwent surgical treatment. Based on regression modeling, annual ED visits are projected to increase substantially by 2035, reaching 43,324 to 53,128 visits for periprosthetic hip fractures and 40,952 to 108,301 visits for periprosthetic knee fractures. Surgical volume is similarly expected to rise, with 22,750 to 29,017 procedures for periprosthetic hip fractures and 23,743 to 31,400 procedures for periprosthetic knee fractures annually. The mean hospital costs are projected to increase to $50,919 to $81,194 per case, with charges exceeding $300,000 for complex surgical procedures.
Conclusions:
Periprosthetic hip and knee fractures constitute a rapidly growing source of health care utilization in the United States. The increasing volume, high acuity, and projected growth of these injuries highlight the need for targeted prevention strategies, system-level resource planning, and optimization of multidisciplinary care pathways to mitigate their expanding clinical and economic impact.
Level Of Evidence:
Level III retrospective cohort.
