Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis

Chatziagorou, Georgios; Lindahl, Hans; Garellick, Göran; Kärrholm, Johan

doi:10.1177/1120700018779558

Cited by 35 publications

(48 citation statements)

References 25 publications

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“…It is therefore unsurprising that the main risk factor for sustaining a PFF is age . The age and gender distribution in our cohort was similar in proportion to other studies . It is postulated that females have a higher incidence of fracture due to lower bone mineral density .…”

Section: Discussionsupporting

confidence: 85%

“…It is postulated that females have a higher incidence of fracture due to lower bone mineral density . The incidence of surgically treated PFF in an analysis of 1751 primary hip prostheses was highest when the patient was 80 years or older . Cook et al .…”

Section: Discussionmentioning

confidence: 99%

“…17,[26][27][28] The age and gender distribution in our cohort was similar in proportion to other studies. [27][28][29][30][31] It is postulated that females have a higher incidence of fracture due to lower bone mineral density. 27 The incidence of surgically treated PFF in an analysis of 1751 primary hip prostheses was highest when the patient was 80 years or older.…”

Section: Discussionmentioning

confidence: 99%

“…27 The incidence of surgically treated PFF in an analysis of 1751 primary hip prostheses was highest when the patient was 80 years or older. 30 Cook et al 17 noted that the age at the time of the index procedure was a risk factor for PFF with a patient 70 years or older being 2.9 times more likely to sustain a PFF compared to patients less than 70 years old and likewise those 80 years or older were 4.4 times more likely than patients less than 80. Revision is also a risk factor for PFF 27 with patients being 5 to 6 times more likely to need further revision compared to the index procedure.…”

Section: Discussionmentioning

confidence: 99%

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Operation rate is more than double the revision rate for periprosthetic femur fractures

Constantin

Steiger

et al. 2019

ANZ Journal of Surgery

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Background Periprosthetic femur fractures (PFFs) following hip arthroplasty can lead to significant morbidity due to their impact on mobility and the need for surgery. Its incidence often measured by the prosthesis revision rate reported in joint replacement registries. However, many PFFs are also treated with prosthesis retention and internal fixation. Minimally displaced and stable fractures may be treated without surgery. Knowledge of the difference between the number of femoral revisions for PFF (well reported in registries) and the number of surgeries for PFF overall would allow us to estimate the overall surgical burden. This study aims to determine the number of post‐operative PFF in three hospitals and compare those treated with revision surgery to those PFF treated with internal fixation and femoral stem retention. By determining this difference, we can ascertain a more accurate estimate of the overall surgical burden of PFF. Method Patients 50 years and older who sustained a post‐operative PFF between 1 January 2011 and 31 December 2017 at three public hospitals were extracted from hospital records. The number of revision procedures was compared to the number of re‐operations of any type. Results There were 200 patients admitted for management of PFF. One hundred and forty‐three (71.5%) required an operation of which 67 (47%) were revision arthroplasty. Conclusion The overall surgical burden of PFF is approximately twice that represented by the revision rate.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Operation rate is more than double the revision rate for periprosthetic femur fractures

Constantin

Steiger

et al. 2019

ANZ Journal of Surgery

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show abstract

“…There is also a possibility that periprosthetic fractures may have occurred in the trochanteric region and might have been misclassified as a pertrochanteric fracture. We do, however, consider that the number of such cases is small and without any significant influence on our results [41]. There might be a selection bias to healthier patients being operated with a TKR, which might affect the results for both before and after TKR, and most likely towards a lower risk of fracture.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 88%

Risk for hip fracture before and after total knee replacement in Sweden

et al. 2019

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We studied the risk for hip fracture before and after total knee replacement (TKR) in the entire population in Sweden. Women and men had a low risk for hip fracture before TKR but an increased risk the first year after TKR. Purpose It is known that osteoarthritis is associated with high bone mass. We therefore studied the risk of hip fracture before and after total knee replacement (TKR), risk of different hip fracture types, and risk subdivided in genders and age groups. Methods We followed the total Swedish population born between 1902 and 1952 (n = 4,258,934) during the period 1987-2002 and identified all patients with TKR due to primary OA (n = 39,291), and all patients with hip fracture (n = 195,860) in the Swedish National Inpatient Register. The risk time analyses were based on Poisson regression models. Results The hazard ratio (HR) for hip fracture the last year before TKR was 0.86 (95% CI 0.74 to 1.00) and the first year after 1.26 (95% CI 1.11 to 1.42) compared to individuals without TKR. The HR for femoral neck fracture 0-10 years after TKR was 0.95 (95% CI 0.89 to 1.01) and for trochanteric fracture was 1.13 (95% CI 1.06 to 1.21). The HR for hip fracture in the age group 50-74 was 1.28 (95% CI 1.14 to 1.43) and in the age group 75-90 years was 0.99 (95% CI 0.94 to 1.04) 0-10 years after TKR, compared to individuals without TKR. Conclusion Individuals had a low risk for hip fracture before TKR but an increased risk the first year after TKR. The risk in individuals below age 75 years and for trochanteric fractures was increased after TKR. Possible explanations include changed knee kinematics after a TKR, physical activity level, fall risk, and other unknown factors.

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Periprosthetic and peri‐implant femoral fractures and timeliness to surgery: A retrospective matched cohort study

Alarcón,

Sköldenberg,

Magnéli

et al. 2024

J. exp. orthop.

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PurposePeriprosthetic (PPFF) and peri‐implant femoral fractures (PIFFs) are troublesome complications of prosthetic and implant surgery, the prior being described to have a greater delay to surgery when compared with standard hip fractures. The implications of PPFF delay being disputed in the current literature and those of PIFF have not been investigated. The aim of this study was to determine whether the time from radiological examination to surgery differs between hip fractures and PPFF/PIFF, and the possible consequences of delay and group affiliation on morbidity, mortality, and readmissions.MethodsOne hundred and thirty‐six participants were admitted to Danderyd hospital during 2020, cases exposed to PPFF or PIFF (n = 35) and hip fracture controls (n = 101) matched at 1:3 with respect to age and sex. Timestamps from radiology, surgery, and death were retrieved from the Swedish fracture registry, data on adverse events (AEs), and readmissions were collected through retrospective medical record review for 90‐days postsurgery.ResultsLinear regression showed that time to surgery differed in case and control cohorts by a mean of 24.8 h, p < 0.001, and AEs were significantly more common in cases, p = 0.046. Unadjusted binary logistic regression indicated a possible relationship between time to surgery increasing the rate of AEs by 1.3% per hour of delay, 95% confidence interval [CI]: (1–1.03).ConclusionThis study reveals a significant delay in surgery for PPFFs and PIFFs compared with standard hip fractures, leading to higher adverse event rates. While mortality and readmissions did not differ significantly, the delay underscores the need for timely intervention in these complex cases. Further research is needed to address these challenges and improve patient outcomes.Level of EvidenceIII

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Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis

Abstract: The incidence of PPFFs has increased in Sweden during the period 2001 to 2011. The improved reporting of type C fractures, after data-linking, revealed an almost 4 times higher incidence compared to previous register studies in Sweden.

Cited by 35 publications

References 25 publications

Operation rate is more than double the revision rate for periprosthetic femur fractures

Operation rate is more than double the revision rate for periprosthetic femur fractures

Risk for hip fracture before and after total knee replacement in Sweden

Periprosthetic and peri‐implant femoral fractures and timeliness to surgery: A retrospective matched cohort study

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