Patient-specific screening tool calculates risk of periprosthetic fracture after THA
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Key takeaways:
- A patient-specific risk calculator can be used regarding periprosthetic femur fracture among patients undergoing THA.
- Operative decisions were the number one risk factor for periprosthetic femur fracture.
LAS VEGAS — A patient-specific screening tool successfully identified risk factors for periprosthetic femur fracture among patients undergoing total hip arthroplasty, according to presented results.
“There are myriad described risk factors for [periprosthetic femur fracture],” Cody Wyles, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “The purpose of this study was to quantify all this together and develop a multimodal periprosthetic fracture risk calculator to determine, firstly, patient-specific risk and secondly, I would argue more importantly, the degree of risk modification that can be achieved with surgical decisions, thus yielding an actionable final tool,” he added.
Wyles and colleagues at the Mayo Clinic analyzed data from 16,696 primary non-oncologic THAs from 1998 to 2018. Among this group, incidence of periprosthetic femur fracture was 3.3% (n = 558 patients) at mean follow-up of 6 years.
Researchers used non-modifiable factors (demographics, comorbidities and indications for surgery), operative decision-making (cemented vs. uncemented THA), surgical approach (direct anterior, lateral or posterior) and implant type (collared vs. collarless) to develop a high-dimensional, patient-specific risk-stratification nomogram.
Overall, patient-specific risk of periprosthetic femur fracture ranged from 0.3% to 17% at 90 days, 0.3% to 19% at 1 year and 0.4% to 22% at 5 years after THA. Multivariable analysis revealed female sex, older age, osteoporosis and an indication for surgery other than osteoarthritis were non-modifiable risk factors for periprosthetic femur fracture. Modifiable risk factors included uncemented femoral fixation, collarless femoral implants and a surgical approach other than direct anterior.
“We were able to create a patient-specific periprosthetic fracture risk calculator that accounts for fracture comorbidities and yielded a final model that is both parsimonious and actionable,” Wyles said. “Periprosthetic fracture risk is very wide-ranging based on a patient’s comorbid profile – anywhere from less than 1% up to about 20%. Nevertheless, as surgeons, we have immense power to modify this risk as operative decisions were shown to be the number one determinant in the final model, and the nomograms from this study can help you risk stratify and individualize choices for your patients,” he concluded.
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Wyles C, et al. Poster 543. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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