Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty

Brandon E. Lung, MD; Megan Donnelly, BS; Kylie Callan, BS; Maddison McLellan, BA; Arya Amirhekmat, MD; William C. McMaster, MD; David H. So, MD; Steven Yang, MD

Arthroplasty Today (Feb 2023)

Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty

Brandon E. Lung, MD,
Megan Donnelly, BS,
Kylie Callan, BS,
Maddison McLellan, BA,
Arya Amirhekmat, MD,
William C. McMaster, MD,
David H. So, MD,
Steven Yang, MD

Affiliations

Brandon E. Lung, MD: Corresponding author. Department of Orthopaedic Surgery, University of California Irvine, 101 City Drive South, PavIII, Orange, CA 92868, USA. Tel.: +1 714 456 7012.; Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
Megan Donnelly, BS: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
Kylie Callan, BS: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
Maddison McLellan, BA: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
Arya Amirhekmat, MD: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
William C. McMaster, MD: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
David H. So, MD: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA
Steven Yang, MD: Department of Orthopaedic Surgery, University of California Irvine, Orange CA, USA

Journal volume & issue: Vol. 19
p. 101093

Abstract

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Background: Periprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes. Methods: All THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA. Results: The analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions. Conclusions: Patients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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