Women aged 70 and older at risk for periprosthetic fracture after THR, TKR

Meek RMD. J Bone Joint Surg – Br. 2011; doi: 10.1302/0301.620X.93B1.25087.

The risk of periprosthetic fracture after lower limb joint replacement was highest in women, in patients aged 70 and older, and after revision arthroplasty, according to investigators in the United Kingdom.

RMD Meek, FRCS, of Southern General Hospital in Glasgow, and colleagues used a population-based linked dataset to assess the 10-year incidence of periprosthetic fracture after total hip replacement (THR) and total knee replacement (TKR).

The analysis showed that between April 1, 1997 and March 31, 2008, surgeons performed 52,136 primary THRs, 44,511 primary TKRs and 3,222 revision TKRs. The fracture rate at 5 years postoperative was as follows:

0.9% after primary THR;
4.2% after revision THR;
0.6% after primary TKR; and
1.7% after revision TKR.

When Meek and colleagues compared the survival analyses for all primary and revision arthroplasties, they found that periprosthetic fractures were more common in women, in patients aged 70 and older and after revision arthroplasty.

“Female patients aged >70 should be warned of a significantly increased risk of periprosthetic fracture after hip or knee replacement,” the authors wrote. “The use of adjuvant medical treatment to reduce the effect of periprosthetic osteoporosis may be a direction of research for these patients.”

The authors of this paper have used the extensive administrative dataset of the Scottish National Database to identify patients with a hip or knee arthroplasty. By linking these patient records to other national databases, they were able to follow them for further contact with the health service for periprosthetic fracture treatment.

Administrative data is often described as a mile wide but an inch deep; however, this type of study is an excellent application of this research resource. The authors have shown in their study of more than 100,000 patients that the 5-year risk of periprosthetic fracture is much higher in revision arthroplasty, the elderly and women. This is useful information that can help inform discussions with patients regarding expected complications following surgery. With the aging population and increased use of arthroplasty, we also must be prepared as a health system to meet the health care needs of these patients with appropriate medical resource planning.

This type of study allows us to project the likely incidence of periprosthetic fracture and serves as a baseline when evaluating potential interventions to reduce the burden of these injuries.

— Richard J. Jenkinson, MD, FRCSC
Orthopaedic Trauma and Joint Reconstruction
Sunnybrook Health Sciences Center
Toronto, Ontario
Canada

Richard J. Jenkinson, MD, FRCSC, has no relevant financial disclosures.