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Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty.
- Source :
-
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2024 Oct; Vol. 35 (10), pp. 1767-1772. Date of Electronic Publication: 2024 Jun 20. - Publication Year :
- 2024
-
Abstract
- Patients who sustain fragility fractures prior to total shoulder arthroplasty have significantly higher risk for bone health-related complications within 8 years of procedure. Identification of these high-risk patients with an emphasis on preoperative, intraoperative, and postoperative bone health optimization may help minimize these preventable complications.<br />Purpose: As the population ages, more patients with osteoporosis are undergoing total shoulder arthroplasty (TSA), including those who have sustained a prior fragility fracture. Sustaining a fragility fracture before TSA has been associated with increased risk of short-term revision rates, periprosthetic fracture (PPF), and secondary fragility fractures but long-term implant survivorship in this patient population is unknown. Therefore, the purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision TSA, periprosthetic fracture, and secondary fragility fracture.<br />Methods: Patients aged 50 years and older who underwent TSA were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3 years prior to TSA. Patients who had a prior fragility fracture (7631) were matched 1:1 to patients who did not based on age, gender, Charlson Comorbidity Index (CCI), smoking, obesity, diabetes mellitus, and alcohol use. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, periprosthetic fracture, and secondary fragility fracture within 8 years of index surgery.<br />Results: The 8-year cumulative incidence of revision TSA (5.7% vs. 4.1%), periprosthetic fracture (3.8% vs. 1.4%), and secondary fragility fracture (46.5% vs. 10.1%) were significantly higher for those who had a prior fragility fracture when compared to those who did not. On multivariable analysis, a prior fragility fracture was associated with higher risks of revision (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.74; p < 0.001), periprosthetic fracture (HR, 2.98; 95% CI, 2.18-4.07; p < 0.001) and secondary fragility fracture (HR, 8.39; 95% CI, 7.62-9.24; p < 0.001).<br />Conclusions: Prior fragility fracture was a significant risk factor for revision, periprosthetic fracture, and secondary fragility fracture within 8 years of primary TSA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications.<br />Level of Evidence: III.<br /> (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
- Subjects :
- Humans
Female
Aged
Male
Middle Aged
Postoperative Complications epidemiology
Postoperative Complications etiology
Aged, 80 and over
Risk Assessment methods
Risk Factors
Recurrence
Databases, Factual
Arthroplasty, Replacement, Shoulder adverse effects
Osteoporotic Fractures epidemiology
Osteoporotic Fractures etiology
Osteoporotic Fractures surgery
Reoperation statistics & numerical data
Periprosthetic Fractures epidemiology
Periprosthetic Fractures etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1433-2965
- Volume :
- 35
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
- Publication Type :
- Academic Journal
- Accession number :
- 38900164
- Full Text :
- https://doi.org/10.1007/s00198-024-07147-9