Total knee replacement linked to increased hip fracture risk in nationwide cohort

  • Vala CH & al.
  • Osteoporos Int
  • 12 Dec 2019

  • International Clinical Digest
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Takeaway

  • Risk for hip fracture was low in the year before total knee replacement (TKR), and rose to 26% in the year after TKR compared with in individuals without TKR in this nationwide cohort study.
  • Subgroup analyses find elevated risk for trochanteric fractures and for people aged

Why this matters

  • Possible explanations include different knee kinematics after TKR, physical activity changes, fall risk, and other unknown contributors.

Study design

  • A retrospective cohort study of all people born in Sweden in 1902-1952 (N=4,258,934) during 1987-2002.
  • The study identified all patients with TKR as a result of osteoarthritis (n=39,291), and all patients with hip fracture (n=195,860) from the Swedish National Inpatient Register.
  • Funding: University of Gothenburg.

Key results

  • Compared with those without TKR, the risk (HR; 95% CI) for hip fracture was:
    • Low in the year before TKR (0.86; 0.74-1.00); but
    • 26% higher the year after (1.26; 1.11-1.42).
  • Elevated risk (HR; 95% CI) for 0-10 years after TKR was found for these subgroups:
    • Trochanteric fractures (1.13; 1.06-1.21).
    • Age 50-74 years (1.28; 1.13-1.46).
  • Compared with the year before TKR, the year after was associated with 46% increased risk (HR, 1.46; 95% CI, 1.21-1.77).

Limitations

  • Retrospective, observational design.