Risk factors and risk-stratified prevention of periprosthetic fractures after hip arthroplasty in patients aged ≥80 years: A retrospective cohort study with prospective validation.

Periprosthetic fractures (PPFs) are a serious complication after hip arthroplasty in very elderly patients. This study aimed to identify risk factors, develop a predictive model, and explore whether risk-stratified interventions are associated with lower PPF incidence. Patients aged ≥80 years undergoing hip arthroplasty for intertrochanteric fractures between April 2021 and May 2024 were retrospectively analyzed to identify independent risk factors for PPF within 12 months using multivariate logistic regression. A predictive model was developed and internally validated. Subsequently, 2 consecutive cohorts (conventional care vs risk-stratified intervention) were compared in a prospective non-randomized design. The intervention group received targeted measures addressing identified risk factors (gender-specific fall prevention, early anti-osteoporosis therapy with Qianggu Capsules and calcium, surgical optimization for cementless prostheses, and enhanced monitoring for prosthesis stability). Primary outcomes were 12-month PPF incidence and bone mineral density (BMD) changes. Independent risk factors were female sex, osteoporosis, cementless prosthesis, and prosthesis loosening. The predictive model showed good discrimination (area under the curve 0.874). In the prospective comparison, PPF incidence was lower in the risk-stratified intervention group than in the conventional care group (1.4% vs 10.0%, P = .029), with greater improvements in femoral neck and greater trochanter BMD (both P < .001). Female sex, osteoporosis, cementless prosthesis use, and prosthesis loosening were independently associated with higher PPF risk in very elderly patients. A risk-stratified intervention protocol was associated with reduced 12-month PPF incidence and improved BMD, suggesting potential clinical benefit of personalized preventive strategies.

Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc.