The Impact of Prior Fragility Fractures on Complications After Total Hip Arthroplasty: A Propensity Score–Matched Cohort Study

Borotschnig

2023

Sci Rep

The fracture risk assessment tool (FRAX) is a tool which calculates an individual 10-year fracture risk based on epidemiological data in patients with a risk of osteporosis. The aim of this study was to evaluate the value of FRAX to estimate the risk of postoperative periprosthetic fractures (PPF) in patients following with total hip and knee arthroplasty. 167 patients (137 periprosthetic fractures in total hip arthroplasty and 30 periprosthetic fractures in total knee arthroplasty) were included in this study. Patients’ data was retrieved retrospectively. In each patient the 10-year probability of a major osteoporotic fracture (MOF) and an osteoporotic hip fracture (HF) was calculated using FRAX. According to the NOGG guideline 57% of total hip arthroplasty (THA) patients and 43.3% of total knee arthroplasty (TKA) patients were in need of osteoporosis treatment, whereas only 8% and 7% received an adequate one respectively. 56% of the patients with PPF after THA and 57% of the patients with PPF after TKA reported about a previous fracture. Significant associations between the 10-year probability of a MOF and HF calculated by FRAX and PPF in THA and TKA were seen. The results of the present study show that FRAX might have the potential to estimate the PPF in patients following THA and TKA. FRAX should be calculated before and after THA or TKA in order to assess the risk and counsel patients. The data show a clear undertreatment of patients with PPF in respect to osteoporosis.

Section: Discussionsupporting

confidence: 59%

Evaluation of FRAX in patients with periprosthetic fractures following primary total hip and knee arthroplasty

Borotschnig

2023

Sci Rep

“…Our findings are in accordance with prior orthopaedic literature, which has demonstrated that prior fragility fracture is strongly predictive of a subsequent fragility fracture, with up to 11.3% of patients sustaining a subsequent fracture within 3 years of their initial fracture. 11,16 In a similar study evaluating the effect of prior fragility fracture after primary THA, Ross et al 13 that prior fragility fracture increased the risk of subsequent fragility fracture, periprosthetic fracture, and allcause revision after a THA. These results call attention to the importance of risk stratification of patients before undergoing SA because periprosthetic fractures are a notable source of morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperatively, surgeons may consider the use of stemless implants, which may decrease the risk of postoperative periprosthetic fracture. 13,17,18 Finally, in the postoperative period, decreasing the fall risk in this population by means of rehabilitation, dementia and delirium precautions, and home assistance all should be considered.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Periprosthetic Fractures and Revision Arthroplasty in Patients Undergoing Shoulder Arthroplasty With a History of Prior Fragility Fractures: A Matched Cohort Analysis

Testa

Albright

Lemme

et al. 2023

J Am Acad Orthop Surg

Introduction:As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures.Methods:A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA. Rates of revision SA, periprosthetic fractures, infection, and postoperative fragility fractures were evaluated using multivariate logistic regression analysis. Risks of these complications were also studied in patients with and without preoperative osteoporosis treatment. Statistical significance was set at P < 0.05.Results:A total of 91,212 SA patients were identified, with 13,050 (14.3%) experiencing a fragility fracture within the 3 years before SA. Two years after SA, there were increased odds of periprosthetic fracture (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.68 to 2.99), fragility fracture (OR 9.11, 95% CI 8.43 to 9.85), deep infection (OR 1.68, 95% CI 1.34 to 2.12), and all-cause revision SA (OR 1.68, 95% CI 1.44 to 1.96) within those patients who had experienced a fragility fracture within 3 years before their SA. Patients who were treated for osteoporosis with bisphosphonates and/or vitamin D supplementation before their SA had similar rates of postoperative periprosthetic fractures, fragility fractures, and all-cause revision SA to those who did not receive pharmacologic treatment.Conclusion:Sustaining a fragility fracture before SA portends substantial postoperative risk of periprosthetic fractures, infection, subsequent fragility fractures, and all-cause revision SA at the 2-year postoperative period. Pharmacotherapy did not markedly decrease the rate of these complications. These results are important for surgeons counseling patients who have experienced prior fragility fractures on the risks of SA.

“…Similarly, other authors have found increased risk of early revision for patients with higher ASA grades at primary surgery, 27 whereas our results indicate reduced risk at mid-late revision, which may be related to a state of poorer general health. Fractures in the pelvis, proximal/ humerus, wrist/forearm, spine or rib may be indicative of fragility, which are also known to increase risk of early revision; 28 patients without a history of these conditions may be at increased risk of mid-late term revision due to longevity. Other findings were a fourfold increased revision risk associated with malabsorption, but it is very rare with only 0.3% of patients having this comorbidity.…”

Section: Discussionmentioning

confidence: 99%

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

et al. 2022

ObjectiveTo identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up.DesignAnalysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)).ParticipantsPrimary elective total hip replacement (THR) aged≥18.Event of interestRevision surgery≥5 years (mid-late term) after primary THR.Statistical methodsCox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.ResultsNJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995–2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01–8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0–20), with 520 (3.1%) mid-late term revisions.Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces.Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95% CI: 1.09 to 6.02)No association of gender, obesity or Index of Multiple Deprivation was observed.ConclusionThe risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.