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

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Griffiths, Richard 
White, Stuart 
Wynn-Jones, Henry 
Aylin, Paul 

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.

adult orthopaedics, epidemiology, geriatric medicine, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, England, Epidemics, Femoral Fractures, Humans, Periprosthetic Fractures, Reoperation
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BMJ Open
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NIHR Funding. Funding statement from article below: AB and PA work at the Dr Foster Unit, an academic unit in the Department of Primary Care and Public Health, Imperial College London. The unit receives research funding from Dr Foster Intelligence, an independent health service research organization (a wholly owned subsidiary of Telstra). The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The NIHR Imperial Patient Safety Translational Centre is a partnership between the Imperial College Healthcare NHS Trust and Imperial College London. The Department of Primary Care and Public Health at Imperial College London is grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) and the Imperial NIHR Biomedical Research Centre. BMD is funded by an NIHR Clinical Lecturer position (CL-2016-14-009). Funders did not have any input to study conception, design, analysis or manuscript writing.