Risk Factors for Periprosthetic Fractures Following Total Hip Arthroplasty in Patients Younger Than 50 Years.

Abstract

Introduction: With the expansion of total hip arthroplasty (THA) into younger populations, the number of periprosthetic fractures (PPF) seen amongst young patients is expected to increase. Therefore, the aim of this study was to identify risk factors for PPF following THA in patients under 50 years.

Methods: In total, 270,986 patients were included in this study. Patients who underwent primary THA with subsequent PPF within two years of surgery were stratified into five age cohorts: under 20, 21 to 30, 31 to 40, 41 to 50, and 51 to 60 years of age. Risk factors were identified using multivariate regression with the age 51-60 years cohort as reference. After applying the Bonferroni correction, a P-value of less than 0.03 was used as the cutoff for significance. All statistical analysis was conducted using R software (Vienna, Austria).

Results: In patients under the age of 50 years, risk factors for PPF included undergoing THA for osteonecrosis (OR (odds ratio): 1.5; P < 0.001). Other risk factors included a history of arrhythmia (OR: 1.4; P < 0.001), peripheral vascular disease (OR: 1.2; P = 0.002), paralysis (OR: 1.3; P = 0.03), neurologic disease (OR: 1.8; P < 0.001), pulmonary disease (OR: 1.3; P < 0.001), chronic kidney disease (OR: 1.3; P < 0.001), anemia with blood loss (OR: 1.6; P = 0.01), and alcohol abuse (OR: 1.9; P = 0.001). Protective factors included hip osteoarthritis (OR: 0.8; P < 0.001), men (OR: 0.7; P < 0.001), and age of 40 to 50 years (OR: 0.8; P < 0.001).

Conclusion: Several risk factors for PPFs following THA in patients under age 50 years were identified. Of note, hip osteoarthritis, men, and age 41 to 50 years were protective factors against PPFs. As the proportion of younger patients undergoing THA continues to increase, our results can be used to guide surgeons in identifying patients at increased risk for PPF and improve patient outcomes.