Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

BMC Musculoskeletal Disorders

Elena Losina²  Mitchel B Harris¹  Julian JZ Polaris¹  Elizabeth A Wright²  Jeffrey N Katz² 

[1] Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA;Division of Rheumatology Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

关键词: Epidemiology;    Risk factor;    Implant;    Fracture;    Periprosthetic fracture;    Hip replacement;   

Others  :  1125707
DOI  :  10.1186/1471-2474-15-168

 received in 2014-01-19, accepted in 2014-05-16,  发布年份 2014

【 摘 要 】

Background

The growing utilization of total joint replacement will increase the frequency of its complications, including periprosthetic fracture. The prevalence and risk factors of periprosthetic fracture require further study, particularly over the course of long-term follow-up. The objective of this study was to estimate the prevalence and risk factors for periprosthetic fractures occurring in recipients of total hip replacement.

Methods

We identified Medicare beneficiaries who had elective primary total hip replacement (THR) for non-fracture diagnoses between July 1995 and June 1996. We followed them using Medicare Part A claims data through 2008. We used ICD-9 codes to identify periprosthetic femoral fractures occurring from 2006–2008. We used the incidence density method to calculate the annual incidence of these fractures and Cox proportional hazards models to identify risk factors for periprosthetic fracture. We also calculated the risk of hospitalization over the subsequent year.

Results

Of 58,521 Medicare beneficiaries who had elective primary THR between July 1995 and June 1996, 32,463 (55%) survived until January 2006. Of these, 215 (0.7%) developed a periprosthetic femoral fracture between 2006 and 2008. The annual incidence of periprosthetic fracture among these individuals was 26 per 10,000 person-years. In the Cox model, a greater risk of periprosthetic fracture was associated with having had a total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hip replacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006. Compared to those without fractures, THR recipients who sustained periprosthetic femoral fracture had three-fold higher risk of hospitalization in the subsequent year (89% vs. 27%, p < 0.0001).

Conclusion

A decade after primary THR, periprosthetic fractures occur annually in 26 per 10,000 persons and are especially frequent in those with prior total knee or revision total hip replacements.

【 授权许可】

   
2014 Katz et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]HCUPnet, Healthcare Cost and Utilization Project, 2010 Rockville, MD: Agency for Healthcare Research and Quality; http://hcupnet.ahrq.gov/ webcite
• [2]Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM: Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 2008, 466(7):1652-1656.
• [3]Lee SR, Bostrom MP: Periprosthetic fractures of the femur after total hip arthroplasty. Instr Course Lect 2004, 53:111-118.
• [4]Sarvilinna R, Huhtala HS, Puolakka TJ, Nevalainen JK, Pajamaki KJ: Periprosthetic fractures in total hip arthroplasty: an epidemiologic study. Int Orthop 2003, 27(6):359-361.
• [5]Della Rocca GJ, Leung KS, Pape HC: Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011, 25(Suppl 2):S66-S70.
• [6]Phillips JR, Boulton C, Morac CG, Manktelov AR: What is the financial cost of treating periprosthetic hip fractures? Injury 2011, 42(2):146-149.
• [7]Singh JA, Lewallen DG: Peptic ulcer disease and heart disease are associated with periprosthetic fractures after total hip replacement. Acta Orthop 2012, 83(4):353-359.
• [8]Lindahl H, Garellick G, Regner H, Herberts P, Malchau H: Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 2006, 88(6):1215-1222.
• [9]Lindahl H, Malchau H, Herberts P, Garellick G: Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty Oct 2005, 20(7):857-865.
• [10]Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA: Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am 2001, 83-A(11):1622-1629.
• [11]Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA: Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Joint Surg Am 2003, 85-A(1):27-32.
• [12]Singh JA, Lewallen DG: Association of peptic ulcer disease and pulmonary disease with risk of periprosthetic fracture after primary total knee arthroplasty. Arthritis Care Res (Hoboken) 2011, 63(10):1471-1476.
• [13]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P: What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012, 2(1):e000435.
• [14]Wu CC, Au MK, Wu SS, Lin LC: Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc 1999, 98(3):190-194.