Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study
نویسندگان
چکیده
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.
منابع مشابه
Peptic ulcer disease and heart disease are associated with periprosthetic fractures after total hip replacement
BACKGROUND AND PURPOSE There have been no published studies assessing the possible association of medical comorbidities with periprosthetic fracture risk. We therefore assessed whether medical comorbidity is associated with risk of periprosthetic fractures after total hip replacement (THR). MATERIAL AND METHODS We used prospectively collected data from 1989-2008 in the Mayo Clinic Total Joint...
متن کاملPrevention of Periprosthetic Joint Infection
Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system....
متن کاملTotal Hip Replacement Revision in a Single Brand Small Cementless Stem – Our Experience after the Findings of the National Joint Registry
Background: Cementless total hip replacement is the common THR performed in England, Wales, Northern Irelandand the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review ofits performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, claritywas not provided on the explanation for this finding. We ...
متن کاملA biomechanical evaluation of the interprosthetic distance as a risk factor for periprosthetic fractures of the femur: does the gap distance matter?
Introduction The treatment of femoral fractures between a proximal and distal prosthetic stem is expected to become a major challenge because of the increasing life expectancy and the rising prevalence of osteoporotic fractures, Total Hip (THA) and Total Knee Arthroplasties (TKA). Although orthopedic surgeons intuitively consider a decreased interprosthetic gap distance as an important risk fac...
متن کامل