# 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.

## Key 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.