Risk factors for the periprosthetic fracture after total hip arthroplasty: a systematic review and meta-analysis

Abstract

Background and Aims: A systematic review and meta-analysis was performed to investigate the risk factors associated with periprosthetic fracture after total hip arthroplasty. Material and Methods: We searched potential studies in the following databases: MEDLINE, Embase, Web of Science, SCOPUS and Cochrane CENTRAL up to December 2013. Newcastle–Ottawa Scale was used to evaluate the methodological quality, and Stata 11.0 was used to perform all the analyses. Results: Seven studies altogether, including 1069 cases of periprosthetic fractures and 74,776 controls, were included in the meta-analysis. Compared to those absent following demographic or medical conditions, patients involved with female gender (odds ratio, 1.534; p < 0.001), advanced age (>80) (odds ratio: 4.203; p < 0.001), revision (odds ratio: 4.398; p < 0.001), rheumatoid arthritis (odds ratio: 2.503; p < 0.001), osteonecrosis (odds ratio: 1.563; p = 0.009), and implant type of Exeter (odds ratio: 1.511; p = 0.017) were more likely to sustain periprosthetic fractures. Osteoarthritis (vs not) (odds ratio: 0.449; p < 0.001) was identified a protective factor for periprosthetic fractures after total hip arthroplasty. The other factors, including lower ages, American Society of Anesthesiologists ≥ 3, and other implant types, were not significant risk factors for periprosthetic fractures. Conclusions: These medical conditions as reminder should be kept in clinicians’ mind and close follow-up should be implemented in patients involved for preventing the occurrence of periprosthetic fractures after total hip arthroplasty.