THR periprosthetic fractures, Vancouver classification
- Two systems, being the intra-operative and post-operative Vancouver systems.
- Post-operative relates to location of fracture, stability of stem, and effectively guides management.
| Type | Description | Management |
|---|---|---|
| A | Fractures around the GT | If less than 2cm displacement, attempt non-operative management. If >2cm displacement, unstable, or otherwise dysfunctional, ORIF |
| B1 | Fractures around the stem, stable stem | ORIF |
| B2 | Fractures around the stem, unstable stem | Revise to long stem prosthesis, and ORIF |
| C | Fractures distal to the stem | Leave THR alone, just ORIF the femoral shaft |
Original publication Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293-304.
TKR periprosthetic fractures, Lewis-Rorabeck classification
- Periprosthetic fractures around TKR’s are most commonly seen around femoral component, and these have significant morbidity and mortality. Fractures around tibial component are relatively rare, as are patella fractures. Patella fractures are also often asymptomatic hence incidence may be underestimated.
- Lewis-Rorabeck is a radiographic classification and is the most commonly used system as it effectively guides management
| Type | Description | Management |
|---|---|---|
| 1 | Fracture above the implant, non- or minimally displaced, with no notable angulation and a stable implant | Can be managed conservatively, IMN / ORIF / MIPO |
| 2 | Fracture above the implant, with displacement and / or angulation | IMN / ORIF / MIPO |
| 3 | Fracture through level of implant, with unstable implant | Distal femur replacement |
Original publication Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am. 1999;30(2):209-14.
References
Author Contributions
Sean Griffiths, WH Resident, 2020
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.