Periprosthetic Femoral Fracture Fixation

Periprosthetic Femoral Fracture Fixation, radiograph of a periprosthetic fracture of the left femur before treatment
Radiograph of a periprosthetic fracture of the left femur before treatment. Image by Jmarchn, Wikimedia Commons, CC BY-SA 3.0.

Indications

  • Fractures around a hip replacement, managed by Vancouver type
  • B1 stable stem, fixation
  • B2 loose stem, revision
  • B3 loose stem with poor bone, revision with augmentation or proximal femoral replacement
  • Vancouver A fractures of the trochanters are often treated without surgery
  • Vancouver C fractures well below the stem are fixed as a standard femoral fracture, protecting the stem with an overlapping plate

Position

  • Lateral decubitus
  • Image intensifier and long plates and revision stems available
  • Prepare the leg free for traction and rotation

Operative Steps

  1. Assess stem stability on X-ray and directly at surgery
  2. B1, locking plate with cables and screws, spanning the whole femur and overlapping the stem
  3. B2, long distally fixed revision stem bypassing the fracture by two cortical diameters
  4. Cerclage the proximal fragments around the new stem
  5. Take tissue samples for culture
  6. Preoperative CRP and ESR, and aspirate if infection is suspected
  7. Lateral approach with an extended trochanteric osteotomy for revision when the stem is well fixed proximally
  8. Restore length and rotation before fixation

Postoperative Care

  • Protected weight bearing
  • Follow up for union and stem subsidence
  • Weight bearing guided by fixation and bone quality
  • Treat osteoporosis after the fracture

Complications

  • Nonunion and fixation failure
  • Dislocation after revision
  • Infection
  • Mortality is similar to that after hip fracture
  • Periprosthetic fracture around the new implant

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.