Periprosthetic fractures after hip and knee arthroplasty in France : national trends and future projections.

Abstract

Aims: This study aimed to provide a nationwide assessment of the incidence, risk factors, morbidity, and mortality of hip and knee periprosthetic fractures in France over the past decade, and to project their future burden up to 2070 under different epidemiological scenarios.

Methods: This nationwide retrospective study used the French National Health Data System to identify all patients who underwent reoperation for hip or knee periprosthetic fracture in France between January 2015 and December 2024. Fracture episodes occurring within three months of each other were considered a single event. Annual incidence rates were calculated per 100,000 inhabitants, and cumulative incidences of complications and mortality were assessed at three months and one year. Long-term projections were generated for 2030 to 2070 using two scenarios: a static model assuming stable incidence, and a dynamic model extrapolating the 2015 to 2024 linear trend adjusted for demographic forecasts.

Results: Over the ten-year period, 15,029 periprosthetic fractures were identified. The mean age was 81 years (SD 11) and 70% (10,571) of patients were female. The incidence doubled from 1.73 to 3.94 per 100,000 inhabitants between 2015 and 2024. Mortality reached 8% at three months and 16% at one year, primarily associated with older age (HR 1.1) and higher comorbidity burden (HR 1.2). Postoperative complications occurred in 16% of patients within three months, including pressure ulcers, procedure-related complications, and cardiovascular events. Projections indicated a 33% and 248% increase in periprosthetic fractures by 2070 under the static and dynamic incidence scenarios, respectively.

Conclusion: The incidence of periprosthetic fractures in France has risen steadily and is expected to increase substantially in the coming decades, driven by demographic ageing. Given their high morbidity and mortality, optimizing perioperative and post-fracture care, along with implementing measures to prevent both fractures and related complications, should be considered a public health priority.