Epidemiology of periprosthetic proximal femur fractures in Slovenia

Jelenc, Urban (author), Vojković, Rok (author), Mavčič, Blaž (author)

Zlom stegnenice ob vstavljeni endoprotezi kolka v proksimalnem delu stegnenice, tj. obprotezni zlom proksimalne stegne-nice (PPF), je eden od treh najpogostejših zapletov v prvih 6 mesecih po totalni artroplastiki kolka (THA) in najpogostejša indikacija za revizijsko operacijo v prvih letih po vstavitvi endoproteze. Zaradi staranja prebivalstva in vse večjega števila vstavljenih endoprotez kolka pri starejših postajajo PPF izziv za ortopedske kirurge. Namen tega preglednega članka je predstaviti epidemiologijo, diagnosticiranje, klasifikacijo in možnosti zdravljenja PPF s poudarkom na Republiki Sloveniji in izvirnih podatkih o tveganju za obprotezni zlom v kohortah operiranih bolnikov v osrednji slovenski terciarni ortopedski bolnišnici – na Ortopedski kliniki, UKC Ljubljana.Trenutna pojavnost PPF v Sloveniji je še vedno v območju 1,6–2,2 % celotnega števila primarnih artroplastik kolka s pri-bližno 70 revizijskimi kirurškimi posegi zaradi obproteznih zlomov na leto po vsej državi. Takšna pojavnost je zelo podobna kot v Nemčiji in Skandinaviji. Poleg starosti, osteoporoze, mišično-skeletne oslabelosti, neustreznih pripomočkov za hojo, uporabe psihoaktivnih zdravil in nezadostne pomoči pri vsakodnevnih aktivnostih je eden od neodvisnih dejavnikov tve-ganja za PPF izbira brezcementnih femoralnih endoprotez pri starejših. V isti slovenski terciarni ortopedski bolnišnici je pričakovana 20-letna kumulativna pojavnost PPF med različnimi femoralnimi vsadki znašala od 1,2–10,0 %. Najpogosteje se uporablja klasifikacija za odločanje o zdravljenju PPF po Vancouverski klasifikaciji in njenem nasledniku New Unified Classification System. Višja povprečna starost, obremenjenost s spremljajočimi boleznimi ob primarni THA, razširjenost osteoporoze in zahtevnejša populacija bolnikov glede mišično-skeletne gibljivosti bodo v naslednjih dveh desetletjih ver-jetno prispevali k povečanju stopnje PPF v Sloveniji in po svetu

• Language: Slovenian
• Keywords: obprotezni zlom, proksimalna stegnenica, artroplastika kolka, epidemiologija
• Work type: Article
• Typology: 1.02 - Review Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: Str. 124-133
• Numbering: Letn. 95, št. 5/6
• PID: 20.500.12556/RUL-187001
• UDC: 616.72-072.1
• ISSN on article: 1318-0347
• DOI: 10.6016/ZdravVestn.3477
• COBISS.SI-ID: 288006659
• Publication date in RUL: 08.09.2026

Record is a part of a journal

• Title: Zdravniški vestnik : glasilo Slovenskega zdravniškega društva
• Publisher: Slovensko zdravniško društvo
• ISSN: 1318-0347
• COBISS.SI-ID: 32893696

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: English
• Title: Epidemiologija obproteznih zlomov proksimalne stegnenice v Sloveniji

Abstract

Fracture of the femoral bone around the implanted hip endoprosthesis in the proximal femur, i.e., the periprosthetic prox-imal femur fracture (PPF), is one of the three most common complications in the first 6 months after total hip arthroplasty (THA) and the most common indication for revision surgery several years after the primary implantation. Due to demo-graphic aging and the growing number of total hip joint replacements in the elderly, PPF is becoming a considerable challenge for orthopaedic surgeons. This review article aims to present the epidemiology, diagnostics, classification, and treatment options of PPFs, with the main emphasis on the Republic of Slovenia and original data on implant-specific periprosthetic fracture risk in operated patient cohorts at the tertiary orthopaedic hospital - Department of Orthopaedic Surgery, University Medical Centre Ljubljana.The current incidence of PPFs in Slovenia remains stable at 1.6-2.2% of the THA burden, with approximately 70 revision THA surgical procedures per year nationwide. These PPF rates correspond well to the proportionately adjusted numbers for Germany and Scandinavia. In addition to age, osteoporosis, musculoskeletal frailness, inadequate walking aids, use of psychoactive medications, and insufficient human assistance in everyday activities, one of the independent risk factors for PPF is the choice of uncemented primary THA femoral implants in the elderly. Even within a single tertiary arthro-plasty centre, the expected 20-year cumulative incidence of subsequent PPF among different THA implants ranged from 1.2% to 10.0%. The most widely applied classification to facilitate decision making regarding treatment is the Vancouver Classification and its expanded successor the New Unified Classification System. Higher mean age and concomitant dis-ease burden at primary THA, widespread prevalence of osteoporosis, and a more demanding patient population in terms of musculoskeletal mobility will likely contribute to an increase in the PPF rates in Slovenia and worldwide over the next two decades.

• Keywords: periprosthetic fracture, proximal femur, hip arthroplasty, epidemiology