Journal of Bone & Joint Surgery reports on ‘the wave of periprosthetic fractures’
Waltham — June 20, 2024 — Rates of periprosthetic fractures (ie, fractures occurring in association with a hip or knee replacement) have risen sharply in recent years, with further increases predicted to occur in the future, reports a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.
“The number of periprosthetic hip and knee fractures is increasing and is expected to continue to rise over the next decade,” according to the new research by Gregory T. Minutillo, MD, MPH, and his colleagues at Penn Medicine, Philadelphia. The findings lend insights into how orthopaedic surgeons are managing the ongoing wave of periprosthetic fractures, including the increased use of fracture repair rather than revision arthroplasty.
Rate of periprosthetic fractures increased by 52% over five years
With use of US insurance claims data from 2016 to 2021, the researchers identified 121,298 patients who underwent surgical treatment for periprosthetic fractures occurring after hip or knee arthroplasty between 2016 and 2021. About 58% of fractures occurred in the hip and 42% in the knee. The patients’ average age was about 78 years, and 70% were women.
Analysis of time trends showed a 52% increase in the overall number of periprosthetic fractures during the study period, with fractures in the hip increasing by 38% and fractures in the knee increasing by 73%. Using a tool called the Prophet model to forecast future trends, the researchers predicted a 212% increase in the total number of periprosthetic fractures by 2032.
Trends in periprosthetic fracture treatment were analyzed as well. For both types of periprosthetic fractures, there was a greater relative increase in the use of open reduction and internal fixation (ORIF) rather than revision joint replacement surgery.
The increase in ORIF use was even greater for patients with hip periprosthetic fractures, although revision arthroplasty continued to be the most frequently used treatment. Throughout the study period, most cases of knee periprosthetic fractures were treated with use of ORIF.
Data show ‘evolving strategy’ in PPFX treatment
The increasing incidence of PPFXs are “primarily attributed to the rise in the number of primary TJAs [total joint arthroplasties] performed,” the researchers write. They add: “As the number of periprosthetic fractures continues to rise, it places a greater demand on the healthcare system and necessitates the involvement of experienced arthroplasty or trauma-trained surgeons to manage these injuries.” Rising surgical costs and an increased demand for rehabilitation services are expected to further add to the economic burden of periprosthetic fractures.
This study is the first to use a large, national database to show rising rates of ORIF for the treatment of periprosthetic fractures. The increasing use of ORIF may reflect advances in surgical technique and implant design, particularly for knee prostheses. Expanded indications for the use of TJA in younger patients may also be a contributing factor.
Within its limitations, the study draws attention to the increasing incidence of hip and knee periprosthetic fractures, as well as trends in surgical treatment for these complex fractures. Dr. Minutillo and coauthors conclude: “The landscape of indications for arthroplasty, implant design, implant fixation technology, and patient characteristics continues to change, making the treatment of periprosthetic fractures an evolving strategy.”