Perioperative Periprosthetic Fractures Associated with Primary Total Hip Arthroplasty

Abstract Objectives Periprosthetic fracture (PPF) is a rare but devastating complication of primary total hip arthroplasty. While PPF is associated with increased morbidity and mortality, early revision rate, and poor patient outcome, there is a paucity of data on patient and hospital-dependent risk...

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Bibliographic Details
Published in:The Journal of arthroplasty 2017-03, Vol.32 (3), p.992-995
Main Authors: Park, Kwan Jun, MD, Menendez, Mariano E., MD, Barnes, C. Lowry, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Arthroplasty, Replacement, Hip - adverse effects
Comorbidity
complication
Female
Humans
Incidence
Male
Middle Aged
Odds Ratio
Orthopedics
outcome
periprosthetic fracture
Periprosthetic Fractures - epidemiology
Periprosthetic Fractures - etiology
primary total hip arthroplasty
Retrospective Studies
Risk Factors
United States - epidemiology
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Summary:Abstract Objectives Periprosthetic fracture (PPF) is a rare but devastating complication of primary total hip arthroplasty. While PPF is associated with increased morbidity and mortality, early revision rate, and poor patient outcome, there is a paucity of data on patient and hospital-dependent risk factors. Using a large administrative database, we investigated epidemiology and the risk factors associated with perioperative PPF after primary total hip arthroplasty. Methods We performed a retrospective review of the National Inpatient Sample (NIS) records from 2006-20011 and identified 1,062 PPF out of 1,187,969 patients using ICD-9 code for periprosthetic fracture (996.44). We then analyzed sociodemographic characteristics, comorbidities, and hospital characteristics of our study population. Results The overall incidence of PPF in NIS database were 0.089% (8.9 per 10,000 THAs). Patient-dependent risk factors were: female (OR 1.93, 95% CI 1.67-2.22), low household income (OR 1.4, 95% CI 1.18-1.65), Medicaid (OR 1.89, 95% CI 1.39-2.57), and uninsured (OR 2.74, 95% CI 1.63-4.61). Patients with malnutrition and hemiparesis/hemiplegia were associated 10-fold and 6-fold risk of PPF. Non-teaching hospitals (OR 1.15, 95% CI 1.01-1.32), hospitals in Northeast (OR 1.29, 95% CI 1.04-1.59), rural hospitals (OR1.27, 95% CI 1.06-1.53) had higher incidence of PPF. Conclusion Our study demonstrates that the incidence of PPF was low in our study population, and greater awareness is needed when performing primary THAs in patients with risk factors identified in our study to prevent PPF.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2016.08.034