Periprosthetic Fractures of the Femur
DNB Orthopaedics • October 2023 • Paper IV • Question 6 • 10 Marks [5+5]
Introduction
A periprosthetic femoral fracture (PFF) is a fracture occurring around, adjacent to, or distal to a femoral prosthesis, most commonly after total hip arthroplasty or hemiarthroplasty. These fractures are increasingly encountered because of the rising number of arthroplasties and the ageing population.
Management is governed primarily by three factors:
Central exam principle: Stable stem → fix the fracture. Loose stem → revise the stem.
Definition
Periprosthetic femoral fractures may occur:
- Intraoperatively during arthroplasty
- Early postoperatively
- Late after trauma or progressive osteolysis / loosening
Risk Factors
Patient factors
- Advanced age
- Osteoporosis
- Female sex
- Neuromuscular disease
- History of falls
- Revision arthroplasty
Implant / surgical factors
- Uncemented stems, particularly during insertion
- Revision stems
- Stress risers
- Cortical perforation
- Osteolysis
- Loose prosthesis
1. Vancouver Classification [5 Marks]
The Vancouver classification is the most widely used system for postoperative periprosthetic femoral fractures after hip arthroplasty. It considers:
- Site of fracture
- Stability of the femoral stem
- Quality of the remaining bone stock
| Type | Location / Stem Status | Key Feature |
|---|---|---|
| A | Trochanteric region | AG = greater trochanter, AL = lesser… |