Periprosthetic fractures: the next fragility fracture epidemic? A national observational study

Abstract

Objectives: Periprosthetic fractures have considerable clinical implications for patients and financial implications for healthcare systems. This study aims to determine the burden of periprosthetic fractures of the lower and upper limbs in England and identify any factors associated with differences in treatment and outcome.

Design: A national, observational study.

Setting: England.

Participants: All individuals admitted to hospital with periprosthetic fractures between 1 April 2015 and 31 December 2018.

Primary and secondary outcome measures: Mortality, length of stay, change in rate of admissions.

Methods: We analysed Hospital Episode Statistics data using the International Classification of Diseases 10th Revision code M96.6 (Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate) to identify periprosthetic fractures recorded between April 2013 and December 2018. We determined the demographics, procedures performed, mortality rates and discharge destinations. Patient characteristics associated with having a procedure during the index admission were estimated using logistic regression. The annual rate of increase in admissions was estimated using Poisson regression.

Results: Between 1 April 2015 and 31 December 2018, there were 13 565 patients who had 18 888 admissions (89.5% emergency) with M96.6 in the primary diagnosis field. There was a 13% year-on-year increase in admissions for periprosthetic fracture in England during that period. Older people, people living in deprived areas and those with heart failure or neurological disorders were less likely to receive an operation. 14.4% of patients did not return home after hospital discharge. The overall inpatient mortality was 4.3% and total 30-day mortality was 3.3%.

Conclusions: The clinical and operational burden of periprosthetic fractures is considerable and increasing rapidly. We suggest that the management of people with periprosthetic fractures should be undertaken and funded in a similar manner to that successfully employed for people sustaining hip fractures, using national standards and data collection to monitor and improve performance.

Keywords: adult orthopaedics; epidemiology; geriatric medicine.

Figure 1

Number of admissions by month from April 2013 to December 2018, with elective and emergency admissions shown separately.

Figure 2

Acute hospital length of stay (LOS) by age and gender.

Figure 3

Acute hospital length of stay (LOS) by operative management.

Figure 4

Kaplan-Meier survival curve by operative status.