Article

There have been no published studies assessing the
possible association of medical comorbidities with periprosthetic fracture risk.
We therefore assessed whether medical comorbidity is associated with risk of
periprosthetic fractures after total hip replacement (THR). Material and methods
We used prospectively collected data from 1989-2008 in the Mayo Clinic Total
Joint Registry for 2 cohorts: primary THR and revision THR. The main variables of
interest were Deyo-Charlson comorbidities at the time of surgery. Outcome of
interest was p ostoperative periprosthetic fracture at postoperative day 1
onwards. Multivariable Cox regression models were additionally adjusted for age,
sex, body mass index, American Society of Anesthesiology (ASA) class, and
operative diagnosis. Results We identified 14,065 primary THRs and 6,281 revision
THRs with mean follow-up times of 6.3 and 5.6 years, respectively. There were 305
postoperative periprosthetic fractures in the primary THR cohort and 330 in the
revision THR cohort. In patients who underwent primary THR, 2 comorbidities were
associated with higher risk of periprosthetic fracture: peptic ulcer disease with
adjusted hazard ratio of 1.5 (95% CI: 1.1-2.2) and heart disease with adjusted
hazard ratio of 1.7 (CI: 1.2-2.4). In patients with revision THR, peptic ulcer
disease was associated with a higher adjusted risk of periprosthetic fracture,
1.6 (CI: 1.1-2.3). Interpretation Peptic ulcer disease and heart disease in
primary THR patients and peptic ulcer disease in revision THR patients were
associated with higher postoperative periprosthetic fracture risk. Further
studies are needed to understand whether disease severity or specific medications
used for treatment, or both, are responsible for this association. This may allow
identification of modifiable factors.

Langue : ANGLAIS