Periprosthetic Fractures after TJA Increased Significantly Over a 5-Year Period
New research from Penn Medicine reports that, “the number of periprosthetic hip and knee fractures is increasing and is expected to continue to rise over the next decade.”
This study, published online ahead of print by The Journal of Bone & Joint Surgery, provides insights into how orthopaedic surgeons are managing the ongoing wave of periprosthetic fractures, including the increased use of fracture repair rather than revision arthroplasty.
5-Year Increase in Periprosthetic Fractures
Using insurance claims data from 2016 to 2021, the researchers identified 121,298 patients who had undergone surgical treatment for periprosthetic fractures occurring after hip or knee arthroplasty between 2016 and 2021, with 58% of the fractures in the hip and 42% in the knee. The patients’ average age was 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, the researchers observed a greater relative increase in the use of open reduction and internal fixation (ORIF) to treat the fractures than revision joint replacement surgery.
The increase in ORIF was even greater for patients with periprosthetic fractures of the hip, although revision arthroplasty continued to be the most frequently used treatment. Throughout the study period, most cases of periprosthetic fractures in the knee were treated with ORIF.
“Evolving Strategy” in Fracture Treatment
The increased incidence of periprosthetic fractures can be “primarily attributed to the rise in the number of primary TJAs [total joint arthroplasties] performed,” the researchers said, adding that, “[a]s 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 that showed an increase in ORIF to treat periprosthetic fractures, which 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. The authors concluded that, “[t]he 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.”
Source
Minutillo GT, Karnuta JM, Koressel J, et al. Fixation or revision for periprosthetic fractures: epidemiology, new trends, and projections in the United States. J Bone Joint Surg Am. 2024 Jun 19;106(12):1054-1061. doi: 10.2106/JBJS.23.00868. Epub 2024 Jun 19.