The growing burden of periprosthetic fractures after total hip arthroplasty: identifying overall trends and at-risk groups

Authors

Amy Y. Zhao, Department of Orthopaedic Surgery, District of Columbia, George Washington University, Washington, USA. zhaoa@gwmail.gwu.edu.
Anthony Chiu, Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA.
Amil R. Agarwal, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Andrew B. Harris, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Alex Gu, Department of Orthopaedic Surgery, District of Columbia, George Washington University, Washington, USA.
Shyam Kurian, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Gregory J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.

Document Type

Journal Article

Publication Date

6-26-2025

Journal

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

DOI

10.1007/s00198-025-07583-1

Keywords

Periprosthetic fracture; Total hip arthroplasty

Abstract

UNLABELLED: Rates of periprosthetic fracture (PPF) after total hip arthroplasty (THA) have doubled since 2010, especially among those with osteoporosis, those under the age of 50, and those with Medicaid insurance. Further work must be done to implement prevention strategies and mitigate the rise in PPF after THA in the United States. PURPOSE: Periprosthetic fractures (PPFs) following primary total hip arthroplasty (THA) contribute significantly to postoperative morbidity, mortality, and healthcare costs. With an aging population and increased utilization of THA in younger patients, there is potential for rates of PPF to increase accordingly. The purpose of this study was to evaluate recent trends in PPF incidence after primary THA and to identify the most affected sub-populations. METHODS: A total of 500,078 patients who underwent primary THA during the years 2010-2019 were identified in a national administrative claims database. Incidence rates of 2-year PPF and a compounded annual growth rate (CAGR) were calculated. A sub-analysis was conducted to stratify baseline characteristics including age, biological sex, and risk factors for PPF. Linear regression was performed to assess trends. RESULTS: The total rate of 2-year PPF demonstrated a + 7.05% annual growth from 2010 to 2019. The most pronounced increases occurred in patients less than 50 years old (CAGR =  + 9.24%, p = 0.005), with comorbid osteoporosis (CAGR =  + 13.7%, p = 0.001), vitamin D deficiency (CAGR =  + 12.2%, p = 0.002), and Medicaid insurance (CAGR =  + 7.19%, p < 0.001). CONCLUSIONS: Rates of PPF following primary THA have nearly doubled since 2010, with the greatest increases among patients with poor bone health, particularly those with osteoporosis and poor underlying bone health. These findings underscore the growing burden of osteoporosis-related complications and highlight the urgent need for improved prevention strategies, including early identification and preoperative bone health optimization. LEVEL OF EVIDENCE: III.

APA Citation

Zhao, Amy Y.; Chiu, Anthony; Agarwal, Amil R.; Harris, Andrew B.; Gu, Alex; Kurian, Shyam; Golladay, Gregory J.; and Thakkar, Savyasachi C., "The growing burden of periprosthetic fractures after total hip arthroplasty: identifying overall trends and at-risk groups" (2025). GW Authored Works. Paper 7366.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7366

Department

School of Medicine and Health Sciences Resident Works