In The Journal of arthroplasty ; h5-index 65.0
BACKGROUND : Many risk factors have been described for periprosthetic femur fracture (PPFFx) following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions.
METHODS : We evaluated 16,696 primary non-oncologic THAs performed between 1998 and 2018. During mean 6-year follow-up, 558 patients (3.3%) sustained PPFFx. Patients were characterized by individual natural language processing-assisted chart review on non-modifiable factors (demographics, THA indication, comorbidities), and modifiable operative decisions (femoral fixation [cemented/uncemented], surgical approach [direct anterior, lateral, posterior], implant type [collared/collarless]). Multivariable Cox regression models and nomograms were developed with PPFFx as a binary outcome at 90-days, 1-year, and 5-years postoperatively.
RESULTS : Patient-specific PPFFx risk based on comorbid profile was wide-ranging from 0.4-18% at 90-days, 0.4-20% at 1-year, and 0.5-25% at 5-years. Among 18 evaluated patient factors, 7 were retained in multivariable analyses. The 4 significant non-modifiable factors included: women (Hazard Ratio (HR)=1.6), older age (HR=1.2 per 10 years), diagnosis of osteoporosis or use of osteoporosis medications (HR=1.7), and indication for surgery other than osteoarthritis (HR=2.2 for fracture, HR=1.8 for inflammatory arthritis, HR=1.7 for osteonecrosis). The 3 modifiable surgical factors were included: uncemented femoral fixation (HR=2.5), collarless femoral implants (HR=1.3), and surgical approach other than direct anterior (lateral HR=2.9, posterior HR=1.9).
CONCLUSION : This patient-specific PPFFx risk calculator demonstrated a wide-ranging risk based on comorbid profile and enables surgeons to quantify risk mitigation based on operative decisions.
Wyles Cody C, Maradit-Kremers Hilal, Fruth Kristin M, Larson Dirk R, Khosravi Bardia, Rouzrokh Pouria, Johnson Quinn J, Berry Daniel J, Sierra Rafael J, Taunton Michael J, Abdel Matthew P
2023-Mar-16
Patient-Specific, Periprosthetic Femur Fracture, Prognosis, Risk Calculator, Risk Modification, Total Hip Arthroplasty
