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Association of osteoporosis and high serum homocysteine levels with intraoperative periprosthetic fracture during total hip arthroplasty: a propensity-score matching analysis

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Intraoperative periprosthetic fracture, one of the most frequent complications of total hip arthroplasty, is a very important factor that affects rehabilitation, hospitalization time, and cost of treatment. Osteoporosis is common in total hip arthroplasty patients and likely contributes to the increasing incidence of periprosthetic fracture. Despite this awareness, preoperative and postoperative osteoporosis evaluations remain insufficient. The purpose of this study was to evaluate the relationships between the occurrence of intraoperative periprosthetic fractures and both bone mineral density (BMD) and osteoporosis-related biomarkers.

Materials and Methods

This single-center retrospective study included a total of consecutive 487 hip joints of patients with a mean age of 65.5 ± 11.8 years who underwent total hip arthroplasty between July 2017 and December 2020. Patients with low BMD defined as T-score < -1.0 versus those with normal BMD were matched by a 1:1 propensity score to balance for patient baseline characteristics, and outcome was analyzed by a modified Poisson regression model. Our primary outcome was the incidence of intraoperative periprosthetic fracture during surgery. We also investigated the effect modification of osteoporosis–related biomarkers, including tartrate-resistant acid phosphatase 5b (TRACP-5b), total procollagen type 1 amino-terminal propeptide (total P1-NP), intact parathyroid hormone (intact PTH), and homocysteine, on osteoporosis and outcomes.

Results

After matching, 250 patients were analyzed. The risk of fracture was significantly higher in patients with low BMD than in normal BMD patients (Incidence rate ratio 5.00 [95% CI 1.11–22.43], p = 0.036). We also observed significant effect of high serum homocysteine on the occurrence of intraoperative fractures (Incidence rate ratio 8.38 × 106 [95% C; 3.44 × 106–2.01 × 107], p < 0.01).

Conclusion

Preoperative osteoporosis and high serum homocysteine levels were risk factors for intraoperative periprosthetic fractures.

Level of evidence

III, A single-center retrospective study.

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Acknowledgements

We thank Ms. Ellen Roider for English editing.

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  1. Naoto Watanabe, Takahisa Ogawa have equally contributed to this manuscript.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Naoto Watanabe, Takahisa Ogawa, Ryohei Takada, Tetsuya Jinno, Toshitaka Yoshii & Atsushi Okawa

  2. Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Hideyuki Koga & Kazumasa Miyatake

  3. Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan

    Tetsuya Jinno

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Contributions

NW and TO designed the study, performed data collection, analysis, and interpretation, and drafted the manuscript. KM, RT, YA, and JT contributed to the study design and data interpretation. HK and TY contributed to restructuring the article. AO contributed to the study design and data interpretation. All authors approved the final article.

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Correspondence to Naoto Watanabe.

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Conflict of interest

Naoto Watanabe, Takahisa Ogawa, Ryohei Takada, Yusuke Amano, Tetsuya Jinno, Hideyuki Koga, Toshitaka Yoshii, Atsushi Okawa, and Kazumasa Miyatake declare that they have no conflict of interest.

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This study was approved by the Medical Research Ethics Committee of Tokyo Medical and Dental University,

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All study subjects provided informed consent and consented to publication. The study protocol conformed to the Declaration of Helsinki.

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402_2023_4989_MOESM1_ESM.pptx

Supplementary Table 1. The baseline characteristics with missing values. DDH: Developmental dysplasia of the hip. OA: Osteoarthritis. ION: Idiopathic osteonecrosis of the femoral head. SIF: Subchondral insufficiency fracture. RDC: Rapidly destructive coxarthropathy. ALS: modified Watson-Jones supine approach. ALA: modified Watson-Jones lateral Approach. PLA: Posterolateral approach. DAA: Direct anterior approach

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Watanabe, N., Ogawa, T., Takada, R. et al. Association of osteoporosis and high serum homocysteine levels with intraoperative periprosthetic fracture during total hip arthroplasty: a propensity-score matching analysis. Arch Orthop Trauma Surg 143, 7219–7227 (2023). https://doi.org/10.1007/s00402-023-04989-6

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