Periprosthetic Fractures: Epidemiology and Future Projections

Rocca, Gregory J. Della; Leung, Kwong Sak; Pape, Hans-Christian

doi:10.1097/bot.0b013e31821b8c28

Cited by 237 publications

(93 citation statements)

References 72 publications

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“…[6,10,20,21] According to our study, the operation time and amount of bleeding of patients with intraoperative PFF in primary THA were all significantly greater than those of controls, and the financial cost for the treatment of PFF was also considerably higher, especially for those using plate or cortical allograft strut during revision. Besides, PFF posed great challenges to orthopedic surgeons because of its common associations with poor follow-up outcomes and high mortality rate.…”

Section: Discussionmentioning

confidence: 83%

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

et al. 2016

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Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case–control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218–20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138–9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001–1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06–5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007–44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103–59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656–38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver classification system, patient's characteristics as well as the experience of the operating surgeon.

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Section: Discussionmentioning

confidence: 83%

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

et al. 2016

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“…It is an increasingly common procedure, with more than 300,000 primary THRs performed in the US every year [1]. As the number of patients with prosthetic joints in place increases, a growing number of individuals are at risk for implant-related complications, including periprosthetic fracture [2-5]. This particular complication is especially important and clinically relevant because it is typically costly, disabling and morbid.…”

Section: Introductionmentioning

confidence: 99%

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

Katz

Wright

Polaris

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe 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.MethodsWe 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.ResultsOf 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).ConclusionA 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.

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“…Periprosthetic fractures of the femur are one of the most severe complications of THA and the number of patients suffering from these injuries will inescapably increase in future years [1,2,23]. Many clinical studies showed devastating outcome results and high complication rates, with hardware failure being one of the most abundant [19,18].…”

Section: Discussionmentioning

confidence: 98%

“…The direct consequence of the worldwide demographic change with a rise of the elderly-but still activepopulation leads to a growing demand for joint arthroplasty in the treatment of osteoarthritis [1,2]. In consequence, the incidence of periprosthetic fractures (PPF) following total hip arthroplasty (THA) is inevitably increasing [3,4].…”

Section: Introductionmentioning

confidence: 99%

Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

Gwinner

Märdian

Dröge

et al. 2015

International Orthopaedics (SICOT)

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Periprosthetic Fractures: Epidemiology and Future Projections

Cited by 237 publications

References 72 publications

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

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

Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

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