Evidence map›Paper›PMID 40569374›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

The growing burden of periprosthetic fractures after total hip arthroplasty: identifying overall trends and at-risk groups.

Amy Y Zhao, Anthony Chiu, Amil R Agarwal, Andrew B Harris, Alex Gu, Shyam Kurian, Gregory J Golladay, Savyasachi C Thakkar

Abstract read
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In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Impact of orthogeriatric care: prescription patterns in hospitalized older adults.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
  2. Article
  3. Vancouver B3 periprosthetic fractures of the femur: options for treatment.Archives of orthopaedic and trauma surgery · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Amy Y ZhaoDepartment of Orthopaedic Surgery, District of Columbia, George Washington University, Washington, USA. zhaoa@gwmail.gwu.edu.ORCID http://orcid.org/0000-0002-0494-4223
Anthony ChiuDepartment of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA.
Amil R AgarwalDepartment of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Andrew B HarrisDepartment of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Alex GuDepartment of Orthopaedic Surgery, District of Columbia, George Washington University, Washington, USA.
Shyam KurianDepartment of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.
Gregory J GolladayDepartment of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Savyasachi C ThakkarDepartment of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Columbia, Baltimore, MD, 21044, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Rates of periprosthetic fracture (PPF) after total hip arthroplasty (THA) have doubled since 2010, especially among those with osteoporosis, those under the age of 50, and those with Medicaid insurance. Further work must be done to implement prevention strategies and mitigate the rise in PPF after THA in the United States. PURPOSE: Periprosthetic fractures (PPFs) following primary total hip arthroplasty (THA) contribute significantly to postoperative morbidity, mortality, and healthcare costs. With an aging population and increased utilization of THA in younger patients, there is potential for rates of PPF to increase accordingly. The purpose of this study was to evaluate recent trends in PPF incidence after primary THA and to identify the most affected sub-populations.

methodsA total of 500,078 patients who underwent primary THA during the years 2010-2019 were identified in a national administrative claims database. Incidence rates of 2-year PPF and a compounded annual growth rate (CAGR) were calculated. A sub-analysis was conducted to stratify baseline characteristics including age, biological sex, and risk factors for PPF. Linear regression was performed to assess trends.

resultsThe total rate of 2-year PPF demonstrated a + 7.05% annual growth from 2010 to 2019. The most pronounced increases occurred in patients less than 50 years old (CAGR =  + 9.24%, p = 0.005), with comorbid osteoporosis (CAGR =  + 13.7%, p = 0.001), vitamin D deficiency (CAGR =  + 12.2%, p = 0.002), and Medicaid insurance (CAGR =  + 7.19%, p < 0.001).

conclusionsRates of PPF following primary THA have nearly doubled since 2010, with the greatest increases among patients with poor bone health, particularly those with osteoporosis and poor underlying bone health. These findings underscore the growing burden of osteoporosis-related complications and highlight the urgent need for improved prevention strategies, including early identification and preoperative bone health optimization. LEVEL OF EVIDENCE: III.

Indexed as

Arthroplasty, Replacement, HipPeriprosthetic FracturesAdultAgedAged, 80 and overDatabases, FactualFemaleHumansIncidenceMaleMiddle AgedOsteoporosisOsteoporotic FracturesPostoperative ComplicationsRetrospective StudiesRisk AssessmentPeriprosthetic fractureTotal hip arthroplasty

Identifiers

PMID40569374

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.