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

BACKGROUND

With the expansion of total hip arthroplasty (THA) into younger populations, the number of periprosthetic fractures (PPFs) seen among young patients is expected to increase. Therefore, the aim of this study was to identify risk factors for PPF following THA in patients younger than 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: younger than 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- to 60-year 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 younger than 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).

CONCLUSIONS

Several risk factors for PPFs following THA in patients younger than 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.