在全肩关节置换术前发生脆性骨折的患者在手术后8年内发生骨健康相关并发症的风险明显更高。对这些高危患者的识别,强调术前,术中,术后骨骼健康优化可能有助于减少这些可预防的并发症。
目标:随着人口老龄化,更多的骨质疏松症患者正在接受全肩关节置换术(TSA),包括那些曾经经历过脆性骨折的人。在TSA之前维持脆性骨折与短期翻修率的风险增加有关。假体周围骨折(PPF),和继发性脆性骨折,但该患者人群的长期植入物存活率未知。因此,这项研究的目的是描述先前的脆性骨折与8年TSA翻修风险的关系,假体周围骨折,和继发性脆性骨折。
方法:在大型国家数据库中确定了50岁及以上接受TSA的患者。根据患者在TSA之前3年内是否持续脆性骨折进行分层。先前有脆性骨折(7631)的患者与没有年龄的患者1:1匹配,性别,Charlson合并症指数(CCI),吸烟,肥胖,糖尿病,酒精的使用。Kaplan-Meier和Cox比例危险分析用于观察全因修正的累积发生率。假体周围骨折,和继发性脆性骨折在8年内的索引手术。
结果:翻修TSA的8年累积发生率(5.7%vs.4.1%),假体周围骨折(3.8%vs.1.4%),和继发性脆性骨折(46.5%vs.与没有骨折的人相比,先前有脆性骨折的人的10.1%)明显更高。在多变量分析中,先前的脆性骨折与较高的翻修风险相关(风险比[HR],1.48;95%置信区间[CI],1.24-1.74;p<0.001),假体周围骨折(HR,2.98;95%CI,2.18-4.07;p<0.001)和继发性脆性骨折(HR,8.39;95%CI,7.62-9.24;p<0.001)。
结论:既往脆性骨折是翻修的重要危险因素,假体周围骨折,原发性TSA术后8年内继发性脆性骨折。识别这些高危患者,强调术前和术后骨骼健康优化可能有助于最大程度地减少这些并发症。
方法:III.
Patients who sustain fragility fractures prior to total shoulder arthroplasty have significantly higher risk for bone health-related complications within 8 years of procedure. Identification of these high-risk patients with an emphasis on preoperative, intraoperative, and postoperative bone health optimization may help minimize these preventable complications.
OBJECTIVE: As the population ages, more patients with osteoporosis are undergoing total shoulder arthroplasty (TSA), including those who have sustained a prior fragility fracture. Sustaining a fragility fracture before TSA has been associated with increased risk of short-term revision rates, periprosthetic fracture (PPF), and secondary fragility fractures but long-term implant survivorship in this patient population is unknown. Therefore, the purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision TSA, periprosthetic fracture, and secondary fragility fracture.
METHODS: Patients aged 50 years and older who underwent TSA were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3 years prior to TSA. Patients who had a prior fragility fracture (7631) were matched 1:1 to patients who did not based on age, gender, Charlson Comorbidity Index (CCI), smoking, obesity, diabetes mellitus, and alcohol use. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, periprosthetic fracture, and secondary fragility fracture within 8 years of index surgery.
RESULTS: The 8-year cumulative incidence of revision TSA (5.7% vs. 4.1%), periprosthetic fracture (3.8% vs. 1.4%), and secondary fragility fracture (46.5% vs. 10.1%) were significantly higher for those who had a prior fragility fracture when compared to those who did not. On multivariable analysis, a prior fragility fracture was associated with higher risks of revision (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.74; p < 0.001), periprosthetic fracture (HR, 2.98; 95% CI, 2.18-4.07; p < 0.001) and secondary fragility fracture (HR, 8.39; 95% CI, 7.62-9.24; p < 0.001).
CONCLUSIONS: Prior fragility fracture was a significant risk factor for revision, periprosthetic fracture, and secondary fragility fracture within 8 years of primary TSA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications.
METHODS: III.