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Periprosthetic Fracture Treatment

Fracture occurring around or below an existing joint replacement (hip, knee, shoulder), classified by Vancouver (hip) or Su/Lewis (knee) systems based on location, fixation status, and bone quality, with management ranging from non-operative for stable patterns to ORIF or revision arthroplasty.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Periprosthetic Fracture Treatment?

Periprosthetic fractures (PPF) are fractures occurring around or in proximity to an existing joint arthroplasty (hip, knee, shoulder, elbow). Incidence is rising as more joint replacements are performed and as the population ages. Pathogenesis involves trauma (falls), bone resorption around implant (stress shielding), osteolysis, prosthesis loosening, and stress risers (cement-bone interface, screw holes).

Classifications are joint and location-specific. For hip femoral PPF: Vancouver classification — Type A (trochanteric, AG greater, AL lesser); Type B (around or just distal to stem tip — B1 well-fixed stem, B2 loose stem with adequate bone, B3 loose stem with poor bone stock); Type C (well distal to stem). For acetabular PPF: classified by location and stability. For knee PPF (around femoral component): Su classification (I above prosthesis, II distal touching prosthesis, III extending into prosthesis) or Rorabeck classification (Type I non-displaced with intact prosthesis, II displaced with intact prosthesis, III loose prosthesis).

Treatment principles: assess implant stability (most critical decision), bone quality, fracture pattern, and patient factors. Vancouver A: non-operative or surgical depending on displacement; B1 (stable stem): ORIF with locking plates ± cerclage cables; B2 (loose stem, good bone): revision with long uncemented stem ± strut allograft; B3 (loose stem, poor bone): revision with long stem and structural allograft, or proximal femoral replacement (megaprosthesis); C: ORIF with long plate spanning beyond stem tip. For knee Rorabeck I: non-operative; II: ORIF with locking plate or retrograde IM nail; III: revision arthroplasty. Adjuncts include bone grafting, cerclage cables, strut allografts. Postoperative protected weight-bearing, multidisciplinary care for elderly. Mortality is high (1-year mortality 10-30% in elderly hip PPF, similar to hip fragility fracture).

Symptoms

Hip or knee pain after fall or trauma in patient with prior arthroplasty
Inability to bear weight on affected limb
Visible deformity, swelling, ecchymosis
Shortened limb (displaced fracture)
Hardware exposure (open fracture)
Pain with passive motion of joint or implant

Risk Factors

Existing joint arthroplasty (hip, knee)
Elderly age, osteoporosis, falls risk
Female sex
Long-standing arthroplasty (loosening, osteolysis)
Cementless stems (slightly higher PPF risk)
Comorbidities: diabetes, rheumatoid arthritis, chronic steroid use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pain after fall in patient with prior joint replacement
  • Inability to bear weight on prosthetic joint
  • Visible deformity around prosthesis
  • Increasing pain in arthroplasty without trauma
  • New limb shortening with prior arthroplasty
  • Suspected loose implant with new fracture

Treatment Methods

01
Emergency assessment: pain, swelling, neurovascular status, soft tissue evaluation
02
Plain radiographs (full femur for hip PPF, full tibia for knee PPF) — assess fracture pattern AND implant stability
03
CT scan for complex patterns and assessment of acetabular/component integrity
04
Vancouver or Rorabeck/Su classification application
05
Critical assessment of implant fixation (loose vs well-fixed) — guides treatment
06
Vancouver A trochanteric: non-operative if minimally displaced, surgical fixation if displaced
07
Vancouver B1 (stable stem): ORIF with locking plate, cerclage cables, strut allograft if needed
08
Vancouver B2 (loose stem, good bone): revision with long uncemented stem (modular taper)
09
Vancouver B3 (loose stem, poor bone): revision with long stem + structural allograft, or proximal femoral replacement
10
Vancouver C (distal to stem): ORIF with long plate spanning past stem tip
11
Knee Rorabeck II: locking plate or retrograde intramedullary nail
12
Knee Rorabeck III: revision arthroplasty (often hinged)
13
Postoperative: protected weight-bearing per surgeon, anticoagulation, fall prevention, osteoporosis treatment
14
Multidisciplinary care for elderly: geriatrics co-management, rehabilitation, secondary fracture prevention

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.