Publication date: May 19, 2025

Periprosthetic fractures (PPFs) following total knee arthroplasty (TKA) result in repeated hospitalizations and incur substantial medical costs. However, the risk factors contributing to PPFs post-TKA remain highly debated. This study provides a comprehensive and quantitative analysis of these risk factors, offering scientific evidence to guide the development of clinical prevention strategies. A systematic literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library databases up to October 1, 2024. We included all English-language studies that evaluated risk factors for PPFs after TKA. The Newcastle-Ottawa Scale (NOS) was leveraged to appraise the quality of the included studies, while odds ratios (OR) and 95% confidence intervals (CI) were utilized to assess the associations between various risk factors and the likelihood of PPFs following TKA. This protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42024601636). A total of 24 studies were included, encompassing 3,759,394 TKA cases. The meta-analysis identified several risk factors for PPFs after TKA, including sex (OR = 1. 81, 95% CI: [1. 12 to 2. 92]), presence of an anterior femoral notching (AFN) (OR = 3. 12, 95% CI: [1. 35 to 7. 20]), osteoporosis (OR = 1. 68, 95% CI: [1. 51 to 1. 87]), Parkinson’s disease (PD) (OR = 7. 48, 95% CI: [1. 15 to 48. 83]), cardiovascular diseases (OR = 2. 23, 95% CI: [1. 01 to 4. 94]), and laterality (OR = 1. 68, 95% CI: [1. 01 to 2. 79]). Sex, osteoporosis, presence of AFN, laterality, PD, and cardiovascular diseases are significant risk factors for PPFs following TKA.

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