Incidence, Risk Factors, and Outcomes of Periprosthetic Fractures Following Total Hip and Knee Arthroplasty: A Multicenter Retrospective Study

TL;DR

This study finds that periprosthetic fractures after hip and knee replacements are more common in older patients with osteoporosis or needing revision surgery.

Contribution

The study provides new insights into risk factors and outcomes of periprosthetic fractures in a multicenter arthroplasty cohort in Pakistan.

Findings

Periprosthetic fractures occurred in 4.6% of arthroplasty cases, more frequently after hip than knee surgery.

Older age, osteoporosis, and revision surgery were identified as independent risk factors for periprosthetic fractures.

Complications after fracture treatment occurred in 33.3% of patients, including re-operation and mortality.

Abstract

Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective procedures for pain relief and functional restoration, but periprosthetic fractures (PPFs) remain a serious complication, associated with functional decline, complex management, and higher healthcare burden.

Objective: To determine the incidence, risk factors, and outcomes of PPF following THA and TKA in a multicenter cohort.

Methodology: A retrospective study was conducted across three tertiary hospitals in Pakistan, including 327 arthroplasty procedures from January 2022 to December 2023. Demographic, clinical, surgical, and follow-up data were reviewed. The primary outcome was the incidence of PPF, while secondary outcomes included risk factors and postoperative complications. Statistical analyses were performed using chi-square, Fisher’s exact, t-test, or Mann-Whitney U test, with logistic regression applied to identify independent predictors. Model fit was assessed with the Hosmer-Lemeshow test, using SPSS version 26.0 (IBM Corp., Armonk, NY), with significance set at p < 0.05.

Results: PPF occurred in 15 patients (4.6%), more frequently after THA (10, 5.8%) than TKA (5, 3.2%). Independent risk factors included age ≥70 years (adjusted odds ratio (aOR): 2.56, 95% CI: 1.04-6.29), osteoporosis (aOR: 3.14, 95% CI: 1.21-8.15), and revision surgery (aOR: 2.89, 95% CI: 1.03-8.10). Treatments included open reduction and internal fixation (ORIF) (11, 73.3%) and revision arthroplasty (4, 26.7%). Complications occurred in five patients (33.3%), including re-operation in three (20%) and mortality in one (6.7%).

Conclusion: PPFs after arthroplasty are strongly linked to older age, osteoporosis, and revision surgery. Optimizing bone health and careful surgical planning are crucial to reduce risk and improve outcomes.

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