Strikingly High Rates of Periprosthetic Joint Infection Following Revision Surgery for Periprosthetic Fractures Regardless of Surgery Timing

Nathanael D Heckmann; JaeWon Yang; Kevin L Ong; Edmund C Lau; Brian C Fuller; Daniel D Bohl; Craig J Della Valle

doi:10.1016/j.arth.2023.12.008

Strikingly High Rates of Periprosthetic Joint Infection Following Revision Surgery for Periprosthetic Fractures Regardless of Surgery Timing

J Arthroplasty. 2024 Jun;39(6):1557-1562.e2. doi: 10.1016/j.arth.2023.12.008. Epub 2023 Dec 16.

Authors

Nathanael D Heckmann¹, JaeWon Yang², Kevin L Ong³, Edmund C Lau⁴, Brian C Fuller⁵, Daniel D Bohl⁶, Craig J Della Valle⁶

Affiliations

¹ Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, California.
² Department of Orthopaedic Surgery, University of Washington, Seattle, Washington.
³ Exponent Inc, Philadelphia, Pennsylvania.
⁴ Exponent Inc, Menlo Park, California.
⁵ OrthoTexas, Carrollton, Texas.
⁶ Department of Orthopaedic Surgery, Rush University, Chicago, Illinois.

PMID: 38104784
DOI: 10.1016/j.arth.2023.12.008

Abstract

Background: Periprosthetic fractures following total hip arthroplasty (THA) often occur in the early postoperative period. Recent data has indicated that early revisions are associated with higher complication rates, particularly periprosthetic joint infection (PJI). The purpose of this study was to assess the effect of timing of periprosthetic fracture surgery on complication rates. We hypothesized that complication rates would be significantly higher in revision surgeries performed within 3 months of the index THA.

Methods: The Medicare Part A claims database was queried from 2010 to 2017 to identify patients who underwent surgery for a periprosthetic fracture following primary THA. Patients were divided based on time between index and revision surgeries: <1, 1 to 2, 2 to 3, 3 to 6, 6 to 9, 9 to 12, and >12 months. Complication rates were compared between groups using multivariate analyses to adjust for demographics, comorbidities, and types of revision surgery.

Results: Of 492,340 THAs identified, 4,368 (0.9%) had a subsequent periprosthetic fracture requiring surgery: 1,725 (39.4%) at <1 month, 693 (15.9%) at 1 to 2 months, 202 (4.6%) at 2 to 3 months, 250 (5.7%) at 3 to 6 months, 134 (3.1%) at 6 to 9 months, 85 (19.4%) at 9 to12 months, and 1,279 (29.3%) at >12 months. The risk of PJI was 11.0% in the <1 month group, 11.1% at 1 to 2 months, 7.9% at 2 to 3 months, 6.8% at 3 to 6 months, 8.2% at 6 to 9 months, 9.4% at 9 to 12 months, and 8.5% at >12 months (P = .12). Adjusting for confounding factors, risk of PJI following periprosthetic fracture surgery was similar regardless of timing (P > .05). Rates of subsequent dislocation and aseptic loosening were also similar regardless of timing.

Conclusions: The risk of PJI following repeat surgery for a periprosthetic fracture was strikingly high regardless of timing (6.8 to 11.1%), underscoring the high-risk of complications.

Keywords: THA; early revision; fracture; periprosthetic fracture; periprosthetic joint infection; total hip arthroplasty.

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Hip* / instrumentation
Female
Hip Prosthesis / adverse effects
Humans
Male
Medicare
Middle Aged
Periprosthetic Fractures* / epidemiology
Periprosthetic Fractures* / etiology
Periprosthetic Fractures* / surgery
Prosthesis-Related Infections* / epidemiology
Prosthesis-Related Infections* / etiology
Reoperation* / statistics & numerical data
Retrospective Studies
Time Factors
United States / epidemiology