Abstract
BACKGROUND: Periprosthetic fracture (PPFx) is a devastating complication following total hip arthroplasty (THA), with concern for higher risk in osteoporotic patients. Lithium is associated with higher bone mineral density, and has emerged as a potential low-cost, widely available method for preventing fractures, promoting fracture healing, and improving implant osseointegration. This study investigated the association between lithium use and risk of PPFx following THA. METHODS: Retrospective review of the PearlDiver Mariner Patient Claims Database was performed, querying all patients who underwent THA for osteoarthritis from 2010 to 2022. Lithium-use patients were those who filled lithium prescriptions for at least 90 days before and 90 days after THA. These patients were propensity-score matched to controls not on lithium in a 1:4 ratio, matching for age, diagnosis of bipolar disorder, gender, body mass index, Charlson Comorbidity Index, and insurance. PPFx rate was compared between groups at 90 days and 2 years postoperatively. Secondarily, rate of aseptic loosening, revision, and prosthetic joint infection were compared between groups. RESULTS: Four thousand six hundred seventy patients were included, with 934 patients on lithium and 3736 controls. There was no difference in PPFx rate (90 day: lithium 1.3% vs no lithium 1.2%, P = .97; 2 year: lithium 1.7% vs no lithium 1.9%, P = .93), aseptic loosening, revision, or prosthetic joint infection. CONCLUSIONS: Despite the theoretical benefit of lithium on bone density, it was not associated with a difference in the rate of PPFx or other surgical complication following THA. Further work is needed to address treatment of osteoporosis and prevention of periprosthetic fracture in the arthroplasty population.