Anatomic and Patient Risk Factors for Postoperative Periprosthetic Hip Fractures: A Case-Control Study |
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| Institution: | 1. Department of Research, New England Baptist Hospital, Boston, MA;2. Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA;1. MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN;2. Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC;1. Department of Orthopaedic Surgery, The Permanente Medical Group, Vallejo, CA;2. Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA;3. Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, CA;4. Department of Orthopaedic Surgery, The Permanente Medical Group, San Leandro, CA;5. Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, CA;1. Orthopedic and Traumatology Unit, Ospedale San Bortolo, Vicenza, Italy;2. Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy;1. Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA;2. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA;3. Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA |
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| Abstract: | BackgroundPeriprosthetic fracture remains a major source of reoperation following total hip arthroplasty (THA). Within 90 days of surgery, fractures may occur spontaneously or with minor injury and are therefore more likely related to patient factors including anatomic variation.MethodsFrom 2008 to 2018, 16,254 primary THAs were performed at our institution; of those, 48 were revised for periprosthetic fracture within 90 days of surgery. A control group of 193 patients undergoing THA for hip osteoarthritis (OA) was randomly selected from the source population. We excluded patients with genetic bone disease and THA performed for hip fracture. We used logistic regression to analyze associations between patient factors (demographics, anatomical factors, comorbidities, surgical technique, and implants) and odds of 90-day periprosthetic fracture.ResultsIncreased age was significantly associated with fracture (P = .002), as was female gender (P = .046). After adjusting for age and gender, absence of contralateral OA was associated with increased odds of fracture relative to patients with contralateral OA (odds ratio OR] 3.85, 95% confidence interval CI] 1.60-9.29), as was having a contralateral THA in place (OR 3.70, 95% CI 1.59-8.60). The neck-shaft angle, femoral offset, and the Dorr classification were not associated with increased odds of fracture. Additionally, the distance from the tip of the trochanter to the top of the femoral head was associated with increased odds of fracture per half centimeter (OR 1.48, 95% CI 1.14-1.93).ConclusionRisk of early postoperative periprosthetic fracture following THA is increased with age, female gender, and increasing distance from the greater trochanter to the top of the femoral head; and decreased in the setting of contralateral hip OA. The trochanter-head distance correlation with periprosthetic hip fracture indicates that the preoperative anatomy may influence PPF, particularly regarding how that anatomy is reconstructed. |
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| Keywords: | total hip arthroplasty total hip replacement periprosthetic hip fracture total hip complications total hip revision |
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