Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA.
Department of Orthopaedic Surgery, The George Washington University, Washington, USA.
Osteoporos Int. 2023 Aug;34(8):1429-1436. doi: 10.1007/s00198-023-06746-2. Epub 2023 May 11.
The study found that patients undergoing total knee arthroplasty with prior fragility fracture had increased risk of subsequent fragility fracture and periprosthetic fracture within 8 years postoperatively when compared to those without a prior history. However, these patients were not at increased risk for all-cause revision within this period.
The aim of this study was to characterize the association of prior FFs on long-term risk of secondary fragility fracture (FF), periprosthetic fracture (PPF), and revision TKA.
Patients at least 50 years of age who underwent elective TKA were identified in the PearlDiver Database. Patients were stratified based on whether they sustained a FF within 3 years prior to TKA (7410 patients) or not (712,954 patients). Demographics and comorbidities were collected. Kaplan Meier analysis was used to observe the cumulative incidence of all-cause revision, PPF, and secondary FF within 8 years of TKA. Cox Proportional hazard ratio analysis was used to statistically compare the risk.
In total, 1.0% of patients had a FF within three years of TKA. Of these patients, only 22.6% and 10.9% had a coded diagnosis of osteoporosis and osteopenia, respectively, at time of TKA. The 8-year cumulative incidence of secondary FF and periprosthetic fracture was significantly higher in those with a prior FF (27.5% secondary FF and 1.9% PPF) when compared to those without (9.1% secondary FF and 0.7% PPF). After adjusting for covariates, patients with a recent FF had significantly higher risks of secondary FF (HR 2.73; p < 0.001) and periprosthetic fracture (HR 1.86; p < 0.001) than those without a recent FF.
Recent FF before TKA is associated with increased risk for additional FF and PPF within 8 years following TKA. Surgeons should ensure appropriate management of fragility fracture is undertaken prior to TKA to minimize fracture risk, and if not, be vigilant to identify patients with prior FF or other bone health risk factors who may have undocumented osteoporosis.
本研究发现，与无既往脆性骨折（FF）病史的患者相比，既往有脆性骨折史的患者在全膝关节置换术后 8 年内发生再次脆性骨折和假体周围骨折的风险增加。然而，这些患者在该期间内并非所有原因的翻修风险增加。
本研究旨在描述既往 FF 对长期继发性脆性骨折（FF）、假体周围骨折（PPF）和翻修 TKA 的风险的相关性。
在 PearlDiver 数据库中确定了至少 50 岁且接受择期 TKA 的患者。根据患者在 TKA 前 3 年内是否发生 FF（7410 例患者）或未发生 FF（712954 例患者）对患者进行分层。收集患者的人口统计学和合并症数据。使用 Kaplan-Meier 分析观察 TKA 后 8 年内所有原因翻修、PPF 和继发性 FF 的累积发生率。使用 Cox 比例风险比分析进行统计学比较。
总共 1.0%的患者在 TKA 前三年内发生 FF。这些患者中，只有 22.6%和 10.9%在 TKA 时分别有骨质疏松和骨量减少的编码诊断。与无近期 FF 患者相比，有近期 FF 患者 8 年的继发性 FF 和假体周围骨折的累积发生率明显更高（27.5%的继发性 FF 和 1.9%的 PPF）。在调整了协变量后，近期发生 FF 的患者发生继发性 FF（HR 2.73；p<0.001）和假体周围骨折（HR 1.86；p<0.001）的风险明显高于无近期 FF 的患者。
TKA 前近期 FF 与 TKA 后 8 年内发生额外 FF 和 PPF 的风险增加相关。外科医生应确保在 TKA 前对脆性骨折进行适当的管理，以降低骨折风险，如果未进行适当的管理，应警惕识别有既往 FF 或其他骨骼健康风险因素但可能存在未记录的骨质疏松症的患者。
