Increased Risk of Proximal Femur Fracture Following Hip Arthroscopy With Increased Age and Tobacco Use

PURPOSE: To determine the incidence and risk factors for proximal femur fracture following hip arthroscopy. METHODS: Using the PearlDiver Mariner 170 Ortho database, patients undergoing hip arthroscopy between 2010 and 2023 were identified via Current Procedural Terminology codes. Subsequent proximal femur fractures at time points 30 days, 90 days, 6 months, and 1 year postoperatively were identified with International Classification of Diseases, Ninth and Tenth Revision codes. Demographic factors and comorbidities were compared between patients with and without fractures. Univariate and multivariate logistic regression analyses were performed. RESULTS: Among 100,397 hip arthroscopy patients, 994 (0.99%) sustained a proximal femur fracture. Patients with fractures were significantly older (mean age 49 vs 39.5 years; P < .0001) and had higher rates of diabetes (22% vs 8%; P < .0001), tobacco use (41% vs 19%; P < .0001), and obesity (29% vs 17%; P < .0001). On multivariate analysis, independent risk factors included tobacco use (adjusted odds ratio, 2.95; 95% confidence interval, 1.87-4.65; P < .001) and increasing age (adjusted odds ratio per year, 1.045; 95% confidence interval, 1.039-1.051; P < .001). CONCLUSIONS: Proximal femur fractures occur in approximately 1% of hip arthroscopy patients. Older age and tobacco use independently increase fracture risk. LEVEL OF EVIDENCE: Level IV, retrospective case series.