Periprosthetic fractures about the femur in total hip replacement

Periprosthetic fractures about the femur in Total Hip Arthroplasty are a difficult challenge facing surgeons, and one that is becoming more common as the arthroplasty population continues to grow. Proper treatment requires a comprehensive understanding of the different fracture patterns and the characteristics and potential pitfalls of each one. The authors suggest an algorithm of treatment based on the Vancouver classification. Fractures around the trochanters can often be treated non-surgically. Fractures about a stable prosthesis can be treated with surgical fixation, while fractures around a loose stem require a combination of fracture fixation and revision to a long stem. A particularly difficult subset of fractures combines a loose stem with significant proximal bone loss. These can be treated with a tumor prosthesis or a long, distally fixed stem combined with structural allograft or impaction grafting.