The Burden of Periprosthetic Fractures Following Total Hip and Knee Arthroplasty: Risk Factors, Trends, and Outcomes

Background Periprosthetic fractures (PPFs) are a significant complication following total hip arthroplasty (THA) and knee arthroplasty (TKA), resulting in substantial patient morbidity. This study aims to quantify the burden of PPF, describe surgical management trends, and identify key patient risk factors in the United States population. Methods A retrospective review of patients undergoing primary unilateral THA or TKA from 2016 to 2022 was performed using the PearlDiver national database. The primary outcome was the burden of PPF in both THA and TKA. Multivariate analyses were performed to identify risk factors for PPF, and univariate analyses were performed to compare outcomes across surgical treatments: open reduction and internal fixation (ORIF), revision, and revision + ORIF combined. Results From 2016 to 2022, the burden of THA PPFs increased from 884 (1.35%) to 1,622 (1.50%), an 11.1% relative increase. The burden of TKA PPFs increased from 669 (0.55%) to 1,147 (0.61%), a 10.9% relative increase. In both populations, increased age, female sex, and higher comorbidity burden were associated with increased risk of PPF. The most common fixation method of PPF after THA was revision, with 2,712 (77.6%) cases, followed by revision + ORIF with 489 (14.0%) cases and ORIF with 295 (8.4%) cases. The most common fixation method of PPF after TKA was revision, with 856 (51.5%) cases, followed by ORIF with 767 (46.2%) cases and revision + ORIF with 38 (2.3%) cases. High 90-day complication rates were observed across treatments. Conclusion The burden of PPFs after THA and TKA increased by approximately 11% from 2016 to 2022, although this did not achieve statistical significance. Targeted strategies for preventing PPFs in high-risk patients and further investigation into optimal treatment methods are warranted, given the high morbidity associated with these injuries.