Periprosthetic Fractures: Classification and Management

Summary Periprosthetic fracture represents a serious complication of both primary and revision total hip arthroplasty. The incidence of periprosthetic fracture is increasing. The risk factors for periprosthetic fracture must be appreciated to help prevent both intra- and postoperative fracture. Acetabular fractures are rare, and relatively little data exist in the literature regarding them. When dealing with periprosthetic femoral fractures, the Vancouver classification system allows an accurate description of all the important features of a periprosthetic fracture, based on the location of the fracture, the stability of the implant, and the quality of the surrounding bone stock. Treatment of periprosthetic femoral fractures is based on the type of fracture. Stable trochanteric fractures may be treated nonoperatively. Shaft fractures at the level of the implant may be treated with internal fixation when the implant is stable. Shaft fractures with an unstable implant may be treated with either revision arthroplasty or revision with proximal femoral replacement, depending on the quality of the remaining bone stock. Shaft fractures well distal to the implant may be treated with standard methods of internal fixation. The physiologic status of the patient should always be considered because operative treatment of these fractures is complex and associated with a relatively high complication rate.