Lung Brandon E, Donnelly Megan, Callan Kylie, McLellan Maddison, Amirhekmat Arya, McMaster William C, So David H, Yang Steven
Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA.
Arthroplast Today. 2023 Jan 16;19:101093. doi: 10.1016/j.artd.2022.101093. eCollection 2023 Feb.
BACKGROUND: Periprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes. METHODS: All THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA. RESULTS: The analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions. CONCLUSIONS: Patients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.
背景：假体周围骨折是全髋关节置换术（THA）的一种毁灭性并发症，且与术后显著更高的死亡率相关。鉴于假体周围骨折给患者以及医疗系统带来的负担，识别并优化合并症对于减少并发症和改善预后至关重要。 方法：从国家外科质量改进计划数据库中查询2007年至2020年所有以骨关节炎为主要指征的THA病例。收集人口统计学数据、术前实验室检查值、合并症、住院过程及急性并发症，并对有或无假体周围骨折再入院的患者进行比较。进行多因素逻辑回归分析以确定初次THA后假体周围骨折的相关独立危险因素。 结果：分析纳入275,107例患者，其中2539例因假体周围骨折再次入院。术后骨折患者更可能年龄较大（>65岁）、为女性、BMI>40且合并症更多。术前低白蛋白血症、低钠血症及异常的估计肾小球滤过率是发生假体周围骨折并在30天内再次入院的独立危险因素。初次THA时同时吸烟和长期使用类固醇等可改变的患者相关因素也是假体周围骨折的独立危险因素。住院时间更长、手术时间更长以及出院至康复机构等住院指标可预测关节置换术后骨折风险。再次骨折入院的患者随后发生手术部位感染、尿路感染及需要输血的风险增加。 结论：低白蛋白血症、低钠血症及估计肾小球滤过率异常的患者在THA后发生假体周围骨折的风险增加。通过密切监测代谢指标和可改变的危险因素进行术前优化，不仅可能有助于预防急性假体周围骨折，还可降低骨折再入院相关的感染和出血风险。
Arthroplast Today. 2023-1-16
Clin Orthop Relat Res. 2015-6
J Am Acad Orthop Surg Glob Res Rev. 2023-2-1
Arthroplast Today. 2025-6-26
BMC Musculoskelet Disord. 2021-12-2
Bone Joint J. 2021-4
J Am Acad Orthop Surg Glob Res Rev. 2020-7
Nutrients. 2020-7-3
Zotero 插件