Ross Austin J, Ross Bailey J, Lee Olivia C, Guild George N, Sherman William F
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
Department of Orthopaedic Surgery & Southeast Louisiana Veterans Health Care System, Louisiana State University School of Medicine, New Orleans, LA.
Arthroplast Today. 2021 Aug 19;11:41-48. doi: 10.1016/j.artd.2021.07.008. eCollection 2021 Oct.
The impact of prior fragility fractures and osteoporosis treatment before total hip arthroplasty (THA) on postoperative complications is unclear. The purpose of this study was to characterize the effect of prior fragility fractures and preoperative osteoporosis treatment on short-term complications and secondary fragility fractures after THA.
A propensity score-matched retrospective cohort study was conducted using a commercially available database to (1) characterize the impact of prior fragility fractures on rates of short-term complications after THA and (2) evaluate if osteoporosis treatment before arthroplasty reduces risk of postoperative complications. Rates of periprosthetic fracture, revision THA, and fragility fractures were compared via multivariable logistic regression.
After 1:1 propensity score matching, 2188 patients were assigned to each cohort. Patients with a fragility fracture in the 3 years preceding THA were more likely to sustain a periprosthetic fracture (1 year: 1.7% vs 1.0%, odds ratio [OR] 1.89; 2 years: 2.1% vs 1.1%, OR 1.82), fragility fracture (1 year: 4.7% vs 1.1%, OR 3.59; 2 years: 6.7% vs 1.7%, OR 3.21), and revision THA (1 year: 2.7% vs 1.7%, OR 1.65; 2 years: 3.1% vs 1.9%, OR 1.58). Among patients with a prior fragility fracture, only 13.8% received osteoporosis pharmacotherapy before THA. Rates of all complications were statistically comparable postoperatively for patients with and without pre-THA osteoporosis treatment.
Fragility fractures within 3 years before THA are associated with significantly increased risk of periprosthetic fracture, all-cause revision, and secondary fragility fractures postoperatively. Preoperative osteoporosis treatment may not decrease risk of postoperative complications.
全髋关节置换术（THA）前既往脆性骨折和骨质疏松治疗对术后并发症的影响尚不清楚。本研究的目的是描述既往脆性骨折和术前骨质疏松治疗对THA术后短期并发症和继发性脆性骨折的影响。
使用一个商业可用数据库进行倾向评分匹配的回顾性队列研究，以（1）描述既往脆性骨折对THA术后短期并发症发生率的影响，以及（2）评估关节置换术前的骨质疏松治疗是否能降低术后并发症风险。通过多变量逻辑回归比较假体周围骨折、翻修THA和脆性骨折的发生率。
经过1:1倾向评分匹配后，每个队列分配了2188例患者。THA前3年内发生脆性骨折的患者更有可能发生假体周围骨折（1年时：1.7%对1.0%，比值比[OR]1.89；2年时：2.1%对1.1%，OR 1.82）、脆性骨折（1年时：4.7%对1.1%，OR 3.59；2年时：6.7%对1.7%，OR 3.21）和翻修THA（1年时：2.7%对1.7%，OR 1.65；2年时：3.1%对1.9%，OR 1.58）。在既往有脆性骨折的患者中，只有13.8%在THA前接受了骨质疏松药物治疗。THA术前接受和未接受骨质疏松治疗的患者术后所有并发症的发生率在统计学上具有可比性。
THA前3年内的脆性骨折与术后假体周围骨折、全因翻修和继发性脆性骨折的风险显著增加相关。术前骨质疏松治疗可能不会降低术后并发症的风险。
