title: The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement.
abstract: Peri-prosthetic fracture after joint replacement in the lower limb is associated with significant morbidity. The primary aim of this study was to investigate the incidence of peri-prosthetic fracture after total hip replacement (THR) and total knee replacement (TKR) over a ten-year period using a population-based linked dataset. Between 1 April 1997 and 31 March 2008, 52,136 primary THRs, 8726 revision THRs, 44,511 primary TKRs, and 3222 revision TKRs were performed. Five years post-operatively, the rate of fracture was 0.9% after primary THR, 4.2% after revision THR, 0.6% after primary TKR and 1.7% after revision TKR. Comparison of survival analysis for all primary and revision arthroplasties showed peri-prosthetic fractures were more likely in females, patients aged > 70 and after revision arthroplasty. Female patients aged > 70 should be warned of a significantly increased risk of peri-prosthetic fracture after hip or knee replacement. The use of adjuvant medical treatment to reduce the effect of peri-prosthetic osteoporosis may be a direction of research for these patients.
authors.affiliation: Scottish Arthroplasty Project, Edinburgh, United Kingdom. rmdmeek@doctors.org.uk
authors.forename: R M D
authors.initials: RM
authors.lastname: Meek
authors.forename: T
authors.initials: T
authors.lastname: Norwood
authors.forename: R
authors.initials: R
authors.lastname: Smith
authors.forename: I J
authors.initials: IJ
authors.lastname: Brenkel
authors.forename: C R
authors.initials: CR
authors.lastname: Howie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D057068:Periprosthetic Fractures / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult