Periprosthetic Femoral Fractures after Total Hip Arthroplasty
Classification and Management • DNB Orthopaedics • May 2024 • Paper IV • 10 Marks
Introduction
A periprosthetic femoral fracture (PFF) is a fracture occurring in the femur around or in relation to a femoral prosthesis following hip arthroplasty. It may occur intraoperatively during stem insertion or postoperatively, most commonly following a low-energy fall in an elderly patient.
These fractures are challenging because management depends not merely on the fracture pattern, but also on femoral stem stability, remaining bone stock, fracture location, implant type and patient factors.
The most important examination principle is: “Where is the fracture? Is the stem loose? Is the bone stock adequate?”
These three questions form the basis of the Vancouver classification and determine treatment.
Clinical Importance
The incidence of periprosthetic fractures is increasing because of:
- Increasing number of primary THAs
- Increasing revision arthroplasty burden
- Longer survival of arthroplasty patients
- Increasing elderly and osteoporotic population
- Greater use of cementless stems
Postoperative PFFs may be associated with substantial morbidity, mortality, prolonged hospitalization and difficult rehabilitation, particularly in elderly patients.
Risk Factors
Patient Factors
- Advanced age
- Osteoporosis
- Female sex
- Neuromuscular disorders
- History of falls
- Rheumatoid arthritis
- Metabolic bone disease