Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany.
Endoprothesenregister Deutschland (EPRD), Berlin, Germany.
Bone Joint J. 2021 Apr;103-B(4):650-658. doi: 10.1302/0301-620X.103B4.BJJ-2020-1046.R2.
Periprosthetic femoral fractures (PPF) are a serious complication of total hip arthroplasty (THA) and are becoming an increasingly common indication for revision arthroplasty with the ageing population. This study aimed to identify potential risk factors for PPF based on an analysis of registry data.
Cases recorded with PPF as the primary indication for revision arthroplasty in the German Arthroplasty Registry (Endoprothesenregister Deutschland (EPRD)), as well as those classified as having a PPF according to the International Classification of Diseases (ICD) codes in patients' insurance records were identified from the complete datasets of 249,639 registered primary hip arthroplasties in the EPRD and included in the analysis.
The incidence of PPFs was higher (24.6%; 1,483) than reported in EPRD annual reports listing PPF as the main reason for revision (10.9%; 654). The majority of fractures occurred intraoperatively and were directly related to the implantation process. Patients who were elderly, female, or had comorbidities were at higher risk of PPFs (p < 0.001). German hospitals with a surgical volume of < 300 primary procedures per year had a higher rate of PPFs (p < 0.001). The use of cemented and collared prostheses had a lower fracture risk PPF compared to uncemented and collarless components, respectively (both p < 0.001). Collared prostheses reduced the risk of PPF irrespective of the fixation method and hospital's surgical volume.
The high proportion of intraoperative fractures emphasises the need to improve surgeon training and surgical technique. Registry data should be interpreted with caution because of potential differences in coding standards between institutions. Cite this article: 2021;103-B(4):650-658.
股骨假体周围骨折（PPF）是全髋关节置换术（THA）的严重并发症，随着人口老龄化，它正成为翻修关节置换术越来越常见的适应证。本研究旨在根据登记数据分析确定 PPF 的潜在危险因素。
从德国关节置换登记处（Endoprothesenregister Deutschland (EPRD)）的 249639 例初次髋关节置换登记完整数据集中，确定了因 PPF 作为翻修主要适应证而记录在案的病例，以及根据患者保险记录中国际疾病分类（ICD）代码分类为 PPF 的病例，并将其纳入分析。
PPF 的发生率（24.6%，1483 例）高于 EPRD 年度报告中列出的 PPF 作为翻修主要原因（10.9%，654 例）。大多数骨折发生在手术过程中，与植入过程直接相关。年龄较大、女性或合并症的患者发生 PPF 的风险更高（p < 0.001）。每年行初次手术<300 例的德国医院，PPF 发生率更高（p < 0.001）。与非骨水泥和无领假体相比，骨水泥和领假体的 PPF 骨折风险较低（两者 p < 0.001）。无论固定方法和医院手术量如何，使用领假体均可降低 PPF 的风险。
术中骨折比例较高，强调需要提高外科医生的培训和手术技术。由于机构之间编码标准可能存在差异，因此应谨慎解释登记数据。引用本文：2021；103-B（4）：650-658。
