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背景：全关节置换术应用的增多会增加其并发症的发生率，包括假体周围骨折的发生。假体周围骨折的发生率和危险因素仍需进一步研究，尤其是需要长期随访观察。本文将为您客观地评估在全髋关节置换术的老年受体中，假体周围骨折的发生率和危险因素。

方法：我们找到了一些医疗保险受益人，他们曾于1995年七月至1996年六月在没有骨折的诊断下优先选择了全髋关节置换术。在他们当中使用医疗保险A部分的人员，我们跟踪了其在2008年的索赔数据。我们使用国际疾病分类第9次修订版来确定2006-2008年间发生股骨假体周围骨折的人员，使用发病率来计算假体周围骨折的平均发生率，使用Cox比例危险率模型来评估假体周围骨折的危险因素，以及估算其再住院风险。

结果：在1995年七月至1996年六月期间优先选择全髋关节置换术的58521个医疗保险受益人中，有32463（55%）人直到2006年一月仍然在世。在他们当中，215（0.7%）人在2006-2008年间发生了股骨假体周围骨折。这些个体中，平均每年10000人中就有26人会发生假体周围骨折。Cox比例危险率模型显示，至2006年，那些优先选择行全髋关节置换的人中，曾经做过全膝关节置换术（风险比 1.82，95% 置信区间1.30,2.55）或者全髋关节置换术（风险比 1.40，95%置信区间 0.95,2.07）的，其发生假体周围骨折的风险更高。曾经发生过股骨假体周围骨折的全髋关节置换术的病人，其再住院风险（89% vs. 27%, p 0.0001）是未发生骨折病人的三倍。

总结：优先选择行全髋关节置换术后十年，平均每年10000人中就有26人会发生假体周围骨折，特别是那些优先行全膝关节置换或全髋关节置换的病人，其发生率更高。

Prevalence and Risk Factors forPeriprosthetic Fracture in Older Recipients of Total Hip Replacement

Abstract

Background. The growing utilization oftotal joint replacement will increase the frequency of its complications,including periprosthetic fracture. The prevalence and risk factors ofperiprosthetic fracture require further study, particularly over the course oflong-term follow-up. The objective of this study was to estimate the prevalenceand risk factors for periprosthetic fractures occurring in recipients of totalhip replacement.

Methods. We identified Medicarebeneficiaries who had elective primary total hip replacement (THR) fornon-fracture diagnoses between July 1995 and June 1996. We followed them usingMedicare Part A claims data through 2008. We used ICD-9 codes to identifyperiprosthetic femoral fractures occurring from 2006–2008. We used the incidencedensity method to calculate the annual incidence of these fractures and Coxproportional hazards models to identify risk factors for periprostheticfracture. We also calculated the risk of hospitalization over the subsequentyear.

Results. Of 58,521 Medicare beneficiarieswho had elective primary THR between July 1995 and June 1996, 32,463 (55%)survived until January 2006. Of these, 215 (0.7%) developed a periprostheticfemoral fracture between 2006 and 2008. The annual incidence of periprostheticfracture among these individuals was 26 per 10,000 person-years. In the Coxmodel, a greater risk of periprosthetic fracture was associated with having hada total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hipreplacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006.Compared to those without fractures, THR recipients who sustainedperiprosthetic femoral fracture had three-fold higher risk of hospitalizationin the subsequent year (89% vs. 27%, p 0.0001).

Conclusion. A decade after primary THR,periprosthetic fractures occur annually in 26 per 10,000 persons and areespecially frequent in those with prior total knee or revision total hipreplacements.