JOA - 2026-09-15 - Journal Article
Quantifying the Age-Dependent Risk of Periprosthetic Femoral Fracture Following Cementless Total Hip Arthroplasty: An Analysis using Age as a Continuous Variable.
Griffith K, Telang SS, Palmer RC, Liu K, Dobitsch A, Lieberman JR, Heckmann ND
Topics
Key Takeaway
In 524,119 cementless THAs, periprosthetic femoral fracture risk increases significantly beyond age 71 in women and 72 in men, with 80-year-olds carrying 26% and 18% higher risk than those at the respective thresholds.
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Summary
This study used a national database of primary cementless THAs (2016–2021) to define age thresholds at which 90-day periprosthetic fracture risk rises significantly, using restricted cubic spline modeling with bootstrap-derived cutpoints. PPFx occurred in 1,169 patients (0.2%), with 73.6% in women. Risk increased beyond age 71 in women and 72 in men, with 80-year-olds demonstrating 26% and 18% higher adjusted risk than patients at their respective thresholds.
Key Limitation
The 90-day observation window captures early periprosthetic fractures but excludes late intraoperative and subacute fractures not coded within that period, and the database cannot confirm whether fractures were intraoperative or postoperative, conflating two mechanistically distinct events.
Original Abstract
INTRODUCTION
It is well-established that the risk of periprosthetic fracture (PPFx) increases with patient age. However, there is no consensus on a critical age threshold beyond which risk rises substantially for cementless fixation. This study sought to identify an age threshold associated with increased PPFx risk among patients undergoing cementless elective total hip arthroplasty (THA).
METHODS
A national database was used to identify all patients who underwent primary cementless THA from 2016 to 2021. The primary outcome of interest was the incidence of PPFx in the 90-day postoperative period. Multivariable logistic regressions were used to generate a restricted cubic spline (RCS) characterizing the relationship between patient age and PPFx risk. After selecting a final RCS model, a bootstrap simulation was used to identify an age cutpoint beyond which PPFx risk increased significantly. The cutpoint was then used as a reference to calculate the adjusted risk of PPFx for all ages between 20 and 89 years. In total, 524,119 THAs, including 286,198 (54.7%) women and 236,782 (45.3%) men, were identified. Of these, 1,169 (0.2%) patients developed PPFx within 90 days, of which 860 (73.6%) were women.
RESULTS
A direct relationship between age and PPFx risk was observed in both men and women, with risk increasing beyond 71 in women and 72 years in men. At age 80 years, PPFx risk was 26% higher in women and 18% higher in men compared with women aged 72 and men aged 71 years, respectively.
DISCUSSION
A direct relationship between patient age and the risk of PPFx was observed in the 90-day postoperative period following cementless THA, with identified cutpoints of 71 years for men and 72 years for women. These threshold values with associated odds ratios may be used to risk-stratify patients before primary THA and assist surgeons in deciding femoral-sided fixation.