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Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases

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Abstract

Summary

Proximal femoral fractures affect elderly people, showing high morbidity and mortality incidence resulting in a major economic burden on national healthcare systems. Understanding the causes of these injuries is of paramount importance to prevent the serious consequences of these fractures.

Introduction

Hip osteoarthritis and proximal femoral fractures mainly affect elderly patients. Several authors, in their studies, tried to document a correlation between these conditions, but the results are conflicting. The aim of this study was to evaluate the relationship between hip osteoarthritis and the fracture site. Secondly, to evaluate if the grade of osteoarthritis could influence the fracture pattern.

Methods

A retrospective study on 320 patients admitted for hip fracture between June 2015 and December 2016 was carried on. Radiographic images were evaluated, assessing the type of fracture, presence and grade of osteoarthritis according to Kellgren-Lawrence and Tönnis classifications, and their correlations.

Results

Osteoarthritis was found to affect the fracture site showing a higher prevalence among subjects with extracapsular than those with intracapsular fractures (p < 0.00001). Patients with radiographic signs of arthritis had mainly trochanteric fracture. Conversely, patients without arthritis more frequently presented a femoral neck fracture. This correlation was even more significant as the severity of the OA increased.

Conclusions

Results support the hypothesis that hip osteoarthritis could represent a protective factor for intracapsular fractures and a risk factor for trochanteric ones. The severity of arthritis is also associated with the fracture pattern.

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References

  1. Zhang Y, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26(3):355–369. https://doi.org/10.1016/j.cger.2010.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  2. Belo JN, Berger MY, Reijman M, Koes BW, Bierma-Zeinstra SMA (2007) Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies. Arthritis Rheum 57(1):13–26. https://doi.org/10.1002/art.22475

    Article  CAS  PubMed  Google Scholar 

  3. Schmidt AH, Swiontkowski MF (2002) Femoral neck fractures. Orthop Clin North Am 33(1):97–111. https://doi.org/10.1016/S0030-5898(03)00074-9

    Article  PubMed  Google Scholar 

  4. Dall’Oca C, Maluta T, Moscolo A, Lavini F, Bartolozzi P (2010) Cement augmentation of intertrochanteric fractures stabilised with intramedullary nailing. Injury 41(11):1150–1155. https://doi.org/10.1016/j.injury.2010.09.026

    Article  PubMed  Google Scholar 

  5. Foss MV, Byers PD (1972) Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis 31:259–264. https://doi.org/10.1136/ard.31.4.259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Chudyk AM, Ashe MC, Gorman E, Al Tunaiji HO, Crossley KM (2012) Risk of hip fracture with hip or knee osteoarthritis: a systematic review. Clin Rheumatol 31:749–757. https://doi.org/10.1007/s10067-012-1970-z

    Article  PubMed  Google Scholar 

  7. Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC et al (1999) Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. Arthritis Rheum 42(7):1378–1385. https://doi.org/10.1002/1529-0131(199907)42:7%3C1378::AID-ANR11%3E3.0.CO;2-I

    Article  CAS  PubMed  Google Scholar 

  8. Dretakis EK, Steriopoulos KA, Kontakis GM, Giaourakis G, Economakis G, Dretakis KE (1998) Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients. Acta Orthop Scand 69(4):384–386. https://doi.org/10.3109/17453679808999051

    Article  CAS  PubMed  Google Scholar 

  9. Robstad B, Frihagen F, Nordsletten L (2012) The rate of hip osteoarthritis in patients with proximal femoral fractures versus hip contusion. Osteoporos Int 23(3):901–905. https://doi.org/10.1007/s00198-011-1628-8

    Article  CAS  PubMed  Google Scholar 

  10. Calderazzi F, Groppi G, Ricotta A, Ceccarelli F (2014) Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study. Hip Int 24(3):231–236. https://doi.org/10.530/hipint.5000116

  11. Garden RS, Preston E (1961) Low angle fixation in fractures of the femoral neck. Surger 101:647

    Google Scholar 

  12. Kellgren J, Lawrence J (1957) Radiological assessment of osteoarthritis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tönnis D, Heinecke A, Nienhaus R, Thiele J (1979) Läßt sich das Auftreten von Arthrose, Schmerz und Bewegungseinschränkung des Huftgelenkes bei Huftdysplasie vorausberechnen. Z Orthop 117:808–815

    PubMed  Google Scholar 

  14. Van Embden D, Rhemrev SJ, Genelin F, Meylaerts SAG, Roukema GR (2012) The reliability of a simplified Garden classification for intracapsular hip fractures. Orthop 98:405–408. https://doi.org/10.1016/j.otsr.2012.02.003

    Article  Google Scholar 

  15. Wright RW, MARS Group (2014) Osteoarthritis classification scales: interobserver reliability and arthoscopic correlation. J Bone Joint Surg Am 96(14):1145–1151. https://doi.org/10.2016/JBJS.M.00929

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aguado-Maestro I, Panteli M, Garcia-Alonso M, Garcia-Cepeda GPV (2017) Hip osteoarthritis as a predictor factor of the fracture pattern in proximal femur fractures. Injury 48S:S41–S46. https://doi.org/10.1016/j.injury.2017.08.037

    Article  Google Scholar 

  17. Yamamoto Y, Turkiewicz A, Wingstrand H, Englund M (2015) Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population. J Rheumatol 42(11):2055–2058. https://doi.org/10.3899/jrheum.150325

    Article  CAS  PubMed  Google Scholar 

  18. Franklin J, Englund M, Ingvarsson T, Lohmander S (2010) The association between hip fracture and hip osteoarthritis: a case-control study. BMC Musculoskelet Disord 11(274). https://doi.org/10.1186/1471-2474-11-274

  19. Cumming RG, Klineberg RJ (1994) Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 42(7):774–778. https://doi.org/10.1111/j.1532-5415.1994.tb06540.x

    Article  CAS  PubMed  Google Scholar 

  20. Cummings SR, Nevitt MC (1994) Non-skeletal determinants of fractures: the potential importance of the mechanics of falls. Osteoporos Int 4(1):s67–s70. https://doi.org/10.1007/BF01623439

    Article  Google Scholar 

  21. Aizen E, Shugaev I, Lenger R (2007) Risk factors and characteristics of falls during inpatient rehabilitation of elderly patients. Arch Gerontol Geriatr 44:1–12. https://doi.org/10.1016/j.archger.2006.01.005

    Article  PubMed  Google Scholar 

  22. McDonough CM, Jette AM (2010) The contribution of osteoarthritis to functional limitation and disability. Clin Geriatr Med 26(3):387–399. https://doi.org/10.1016/j.cger.2010.04.001

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wolf O, Ström H, Milbrink J, Larsson S, Mallmin H (2009) Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips. Acta Orthop 80(3):308–313. https://doi.org/10.3109/17453670903039528

    Article  PubMed  PubMed Central  Google Scholar 

  24. Li B, Aspden RM (1997) Material properties of bone from the femoral neck and calcar femorale of patients with osteoporosis or osteoarthritis. Osteoporos Int 7(5):450–456. https://doi.org/10.1007/s001980050032

    Article  CAS  PubMed  Google Scholar 

  25. Stewart A, Black AJ (2000) Bone mineral density in osteoarthritis. Curr Opin Rheumatol 12:464–467. https://doi.org/10.1097/00002281-200009000-00021

    Article  CAS  PubMed  Google Scholar 

  26. Blain H, Chavassieux P, Portero-Muzy N, Bonnel F, Canovas F, Chammas M, Maury P, Delmas PD (2008) Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. Bone 43(5):862–868. https://doi.org/10.1016/j.bone.2008.07.236

    Article  CAS  PubMed  Google Scholar 

  27. Kuhns BD, Weber AE, Levy DM, Wuerz TH (2015) The natural history of femoroacetabular impingement. Front Surg 2(58). https://doi.org/10.3389/fsurg.2015.00058

  28. Iolascon G, Gravina P, Luciano F, Palladino C, Gimigliano F (2013) Characteristics and circumstances of falls in hip fractures. Aging Clin Exp Res 25(1):133–135. https://doi.org/10.1007/s40520-013-0115-9

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy

    Tommaso Maluta, Giovanna Toso, Stefano Negri, Elena Manuela Samaila & Bruno Magnan

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  1. Tommaso Maluta
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  2. Giovanna Toso
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  3. Stefano Negri
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  4. Elena Manuela Samaila
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  5. Bruno Magnan
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Correspondence to Tommaso Maluta.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Maluta, T., Toso, G., Negri, S. et al. Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases. Osteoporos Int 30, 1591–1596 (2019). https://doi.org/10.1007/s00198-019-05015-5

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