Periprosthetic fractures in total hip arthroplasty (THA) are a significant problem facing hip surgeons, and were responsible for revision surgery in 9% of single stage revision THAs recorded in the National Joint Registry of England and Wales (NJR) in 2012; the 5th most common cause after aseptic loosening, osteolysis, pain and dislocation. The incidence has increased along with the number of THAs performed. Implants and techniques of THA continue to evolve, surgical indications are expanding and the number performed annually continues to rise. Furthermore, patients are undergoing THA earlier and living longer, leading to a rise in the average number of years at risk for periprosthetic fracture. In this review we will discuss the epidemiology of femoral periprosthetic fractures, their prevention, classification and the evidence base for their treatment.
Steering Commitee NJR. National Joint Registry for England, Wales and Northern Ireland: 10th Annual Report.2013Available at: http://www.njrcentre.org.uk/. Accessed December102013
2.
BerryDJEpidemiology: hip and knee.Orthop Clin North Am1999302183–190
3.
MorreyBFKavanaghBFComplications with revision of the femoral component of total hip arthroplasty.Comparison between cemented and uncemented techniques. J Arthroplasty19927171–79
4.
MeekRMDGarbuzDSMasriBAGreidanusNVDuncanCPIntraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem.J Bone Joint Surg Am2004863480–485
5.
LarsonJEChaoEYFitzgeraldRHBypassing femoral cortical defects with cemented intramedullary stems.J Orthop Res199193414–421
6.
SchmidtAHKyleRFPeriprosthetic fractures of the femur.Orthop Clin North Am2002331143–152ix.
7.
GarbuzDSMasriBADuncanCPPeriprosthetic fractures of the femur: principles of prevention and management.Instr Course Lect199847237–242
8.
McElfreshECCoventryMBFemoral and pelvic fractures after total hip arthroplasty.J Bone Joint Surg Am1974563483–492
9.
MeekRMDNorwoodTSmithRBrenkelIJHowieCRThe risk of peri-prosthetic fracture after primary and revision total hip and knee replacement.J Bone Joint Surg Br201193196–101
10.
LindahlHMalchauHHerbertsPGarellickGPeriprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register.J Arthroplasty2005207857–865
11.
BerryDJPeriprosthetic fractures associated with osteolysis: a problem on the rise.J Arthroplasty2003183 Suppl 1107–111
12.
MalchauHHerbertsPAhnfeltLPrognosis of total hip replacement in Sweden.Follow-up of 92,675 operations performed 1978-1990.Acta Orthop Scand1993645497–506
13.
MalchauHHerbertsPEislerTGarellickGSödermanPThe Swedish Total Hip Replacement Register.J Bone Joint Surg Am200284-ASuppl 22–20
14.
LindahlHThe periprosthetic femur fracture. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University;20061 p.
15.
WuCCAuMKWuSSLinLCRisk factors for postoperative femoral fracture in cementless hip arthroplasty.J Formos Med Assoc1999983190–194
16.
BetheaJSIIIDeAndradeJRFlemingLLLindenbaumSDWelchRBProximal femoral fractures following total hip arthroplasty.Clin Orthop Relat Res198217095–106
17.
FredinHOLindbergHCarlssonASFemoral fracture following hip arthroplasty.Acta Orthop Scand198758120–22
18.
JensenJSBarfodGHansenDFemoral shaft fracture after hip arthroplasty.Acta Orthop Scand19885919–13
19.
BealsRKTowerSSPeriprosthetic fractures of the femur.An analysis of 93 fractures.Clin Orthop Relat Res1996327238–246
20.
JohanssonJEMcBroomRBarringtonTWHunterGAFracture of the ipsilateral femur in patients wih total hip replacement.J Bone Joint Surg Am19816391435–1442
21.
TsiridisEHaddadFSGieGAThe management of periprosthetic femoral fractures around hip replacements.Injury200334295–105
22.
SarvilinnaRHuhtalaHSASoveliusRTHalonenPJNevalainenJKPajamäkiKJKFactors predisposing to periprosthetic fracture after hip arthroplasty: a case (n = 31)-control study.Acta Orthop Scand200475116–20
23.
GreidanusNVChihabSGarbuzDSOutcomes of minimally invasive anterolateral THA are not superior to those of minimally invasive direct lateral and posterolateral THA.Clin Orthop Relat Res20134712463–471
24.
MasriBACampbellDGGarbuzDSDuncanCPSeven specialized exposures for revision hip and knee replacement.Orthop Clin North Am1998292229–240
25.
MitchellPAGreidanusNVMasriBAGarbuzDSDuncanCPThe prevention of periprosthetic fractures of the femur during and after total hip arthroplasty.Instr Course Lect200352301–308
26.
SydneySVMalloryTHControlled perforation. A safe method of cement removal from the femoral canal.Clin Orthop Relat Res1990253168–172
27.
StuchinSAFemoral shaft fracture in porous and press-fit total hip arthroplasty.Orthop Rev1990192153–159
28.
MalloryTHKrausTJVaughnBKIntraoperative femoral fractures associated with cementless total hip arthroplasty.Orthopedics1989122231–239
29.
TowerSSBealsRKFractures of the femur after hip replacement: the Oregon experience.Orthop Clin North Am1999302235–247
30.
DuncanCPMasriBAFractures of the femur after hip replacement.Instr Course Lect199544293–304
31.
BradyOHGarbuzDSMasriBADuncanCPThe reliability and validity of the Vancouver classification of femoral fractures after hip replacement.J Arthroplasty200015159–62
32.
RayanFDoddMHaddadFSEuropean validation of the Vancouver classification of periprosthetic proximal femoral fractures.J Bone Joint Surg Br200890121576–1579
33.
NaqviGABaigSAAwanNInterobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty.J Arthroplasty20122761047–1050
34.
PritchettJWFracture of the greater trochanter after hip replacement.Clin Orthop Relat Res2001390221–226
35.
Van HouwelingenAPDuncanCPThe pseudo A(LT) periprosthetic fracture: it's really a B2.Orthopedics2011349e479–e481
36.
RicciWMBolhofnerBRLoftusTCoxCMitchellSBorrelliJJrIndirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant.J Bone Joint Surg Am200587102240–2245
37.
RicciWMBolhofnerBRLoftusTCoxCMitchellSBorrelliJIndirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. Surgical Technique.J Bone Joint Surg Am200688Suppl 1 Pt 2 1_suppl_2275–82
38.
RichardsCJGarbuzDSMasriBADuncanCPVancouver type B3 periprosthetic fractures: evaluation and treatment.Instr Course Lect200958177–181
39.
ChandlerHPKingDLimbirdRThe use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses.Semin Arthroplasty19934299–107
40.
ChandlerHPTiggesRGThe role of allografts in the treatment of periprosthetic femoral fractures.Instr Course Lect199847257–264
41.
MasriBAMeekRMDDuncanCPPeriprosthetic fractures evaluation and treatment.Clin Orthop Relat Res200442080–95
42.
HaddadFSDuncanCPBerryDJLewallenDGGrossAEChandlerHPPeriprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate.J Bone Joint Surg Am2002846945–950
43.
EbraheimNAGomezCRamineniSKLiuJFixation of periprosthetic femoral shaft fractures adjacent to a well-fixed femoral stem with reversed distal femoral locking plate.J Trauma20096641152–1157
44.
VenuKMKokaRGarikipatiRShenavaYMadhuTSDall-Miles cable and plate fixation for the treatment of peri-prosthetic femoral fractures-analysis of results in 13 cases.Injury2001325395–400
45.
TadrossTSNanuAMBuchananMJCheckettsRGDall-Miles plating for periprosthetic B1 fractures of the femur.J Arthroplasty200015147–51
46.
SoenenMMigaudHBonnometFGirardJMathevonHEhlingerMInterprosthetic femoral fractures: analysis of 14 cases.Proposal for an additional grade in the Vancouver and SoFCOT classifications. Orthop Traumatol Surg Res2011977693–698
47.
SahAPMarshallAVirkusWVEstokDMIIDella ValleCJInterprosthetic fractures of the femur: treatment with a single-locked plate.J Arthroplasty2010252280–286
48.
KennyPRiceJQuinlanWInterprosthetic fracture of the femoral shaft.J Arthroplasty1998133361–364
49.
KamineniSVindlacheruvuRWareHEPeri-prosthetic femoral shaft fractures treated with plate and cable fixation.Injury1999304261–268
50.
LindahlHMalchauHOdénAGarellickGRisk factors for failure after treatment of a periprosthetic fracture of the femur.J Bone Joint Surg Br200688126–30
51.
MontMAMaarDCFractures of the ipsilateral femur after hip arthroplasty.A statistical analysis of outcome based on 487 patients. J Arthroplasty199495511–519
52.
TsiridisENarvaniAAHaddadFSTimperleyJAGieGAImpaction femoral allografting and cemented revision for periprosthetic femoral fractures.J Bone Joint Surg Br20048681124–1132
53.
LindahlHGarellickGRegnérHHerbertsPMalchauHThree hundred and twenty-one periprosthetic femoral fractures.J Bone Joint Surg Am20068861215–1222
54.
MacDonaldSJPaproskyWGJablonskyWSMagnusRGPeriprosthetic femoral fractures treated with a long-stem cementless component.J Arthroplasty2001163379–383
55.
IncavoSJBeardDMPupparoFRiesMWiedelJOne-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty.Am J Orthop (Belle Mead NJ)199827135–41
56.
LevineBRDella ValleCJLewisPBergerRASporerSMPaproskyWExtended trochanteric osteotomy for the treatment of vancouver B2/B3 periprosthetic fractures of the femur.J Arthroplasty2008234527–533
57.
GarbuzDSTomsAMasriBADuncanCPImproved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems.Clin Orthop Relat Res20064537199–202
58.
GrossAEAllenGLavoieGRevision arthroplasty using allograft bone.Instr Course Lect199342363–380
59.
MauryACPressmanACayenBZalzalPBacksteinDGrossAProximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty.J Bone Joint Surg Am2006885953–958
60.
HaddadFSGarbuzDSMasriBADuncanCPHutchisonCRGrossAEFemoral bone loss in patients managed with revision hip replacement: results of circumferential allograft replacement.Instr Course Lect200049147–162
61.
IncavoSJMihalichRMCoughlinKMA stem-allograft composite for femoral revision in total hip arthroplasty.J Arthroplasty20031881064–1066
62.
SimFHChaoEYHip salvage by proximal femoral replacement.J Bone Joint Surg Am19816381228–1239
63.
MalkaniALSettecerriJJSimFHChaoEYWallrichsSLLong-term results of proximal femoral replacement for non-neoplastic disorders.J Bone Joint Surg Br1995773351–356
64.
ParviziJTarityTDSlenkerNProximal femoral replacement in patients with non-neoplastic conditions.J Bone Joint Surg Am20078951036–1043
65.
Al-TakiMMMasriBADuncanCPGarbuzDSQuality of life following proximal femoral replacement using a modular system in revision THA.Clin Orthop Relat Res20114692470–475
66.
KleinGRParviziJRapuriVProximal femoral replacement for the treatment of periprosthetic fractures.J Bone Joint Surg Am20058781777–1781
67.
McInnisDPHorneGDevanePAFemoral revision with a fluted, tapered, modular stem seventy patients followed for a mean of 3.9 years.J Arthroplasty2006213372–380
68.
ParkY-SMoonY-WLimS-JRevision total hip arthroplasty using a fluted and tapered modular distal fixation stem with and without extended trochanteric osteotomy.J Arthroplasty2007227993–999
69.
MummeTMüller-RathRAndereyaSWirtzDCUncemented femoral revision arthroplasty using the modular revision prosthesis MRP-TITAN revision stem.Oper Orthop Traumatol200719156–77
70.
de MenezesDFLe BéguecPSieberH-PGoldschildMStem and osteotomy length are critical for success of the transfemoral approach and cementless stem revision.Clin Orthop Relat Res20124703883–888
71.
SomersJFSuyRStuyckJMulierMFabryGConservative treatment of femoral shaft fractures in patients with total hip arthroplasty.J Arthroplasty1998132162–171
72.
ChakravarthyJBansalRCooperJLocking plate osteosynthesis for Vancouver Type B1 and Type C periprosthetic fractures of femur: a report on 12 patients.Injury2007386725–733
73.
CurrallVThomasonKEastaugh-WaringSWardAJChesserTJSThe use of LISS femoral locking plates and cabling in the treatment of periprosthetic fractures around stable proximal femoral implants in elderly patients.Hip Int2008183207–211
74.
KobbePKlemmRReilmannHHockertzTJLess invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up.Injury2008394472–479
75.
LaurerHLWutzlerSPossnerSOutcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty.Arch Orthop Trauma Surg20111317983–989
76.
GreidanusNVMitchellPAMasriBAGarbuzDSDuncanCPPrinciples of management and results of treating the fractured femur during and after total hip arthroplasty.Instr Course Lect200352309–322
77.
SchwartzJTJrMayerJGEnghCAFemoral fracture during non-cemented total hip arthroplasty.J Bone Joint Surg Am19897181135–1142
78.
ZarinJSZurakowskiDBurkeDWClaw plate fixation of the greater trochanter in revision total hip arthroplasty.J Arthroplasty2009242272–280
79.
HamadoucheMZniberBDumaineVKerboullMCourpiedJPReattachment of the ununited greater trochanter following total hip arthroplasty.The use of a trochanteric claw plate.J Bone Joint Surg Am20038571330–1337
80.
HarrisWHCrothersODReattachment of the greater trochanter in total hip-replacement arthroplasty.A new technique.J Bone Joint Surg Am1978602211–213
81.
CharnleyJLow Friction Arthroplasty of the Hip.Berlin Heidelberg New YorkSpringer-Verlag1979
82.
WroblewskiBMShelleyPReattachment of the greater trochanter after hip replacement.J Bone Joint Surg Br1985675736–740
83.
KoyamaKHiguchiFKuboMOkawaTInoueAReattachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty.J Orthop Sci20016122–27
84.
YoungerTIBradfordMSMagnusREPaproskyWGExtended proximal femoral osteotomy.A new technique for femoral revision arthroplasty.J Arthroplasty1995103329–338
85.
FitzgeraldRHJrBrindleyGWKavanaghBFThe uncemented total hip arthroplasty. Intraoperative femoral fractures.Clin Orthop Relat Res198823561–66
86.
HaddadFSDuncanCPCortical onlay allograft struts in the treatment of periprosthetic femoral fractures.Instr Course Lect200352291–300
DennisMGSimonJAKummerFJKovalKJDiCesarePEFixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques.J Arthroplasty2000154523–528
89.
CookREJenkinsPJWalmsleyPJPattonJTRobinsonCMRisk factors for periprosthetic fractures of the hip: a survivorship analysis.Clin Orthop Relat Res200846671652–1656
90.
LöwenhielmGHanssonLIKärrholmJFracture of the lower extremity after total hip replacement.Arch Orthop Trauma Surg19891083141–143
91.
KavanaghBFFemoral fractures associated with total hip arthroplasty.Orthop Clin North Am1992232249–257
92.
SinghJAJensenMRLewallenDGPatient factors predict periprosthetic fractures after revision total hip arthroplasty.J Arthroplasty20122781507–1512
