{"id":5282,"date":"2025-02-23T14:09:00","date_gmt":"2025-02-23T14:09:00","guid":{"rendered":"https:\/\/www.orthogate.org\/press\/uncategorized\/periprosthetic-fracture-management-and-fixation\/"},"modified":"2025-02-23T23:01:34","modified_gmt":"2025-02-23T23:01:34","slug":"periprosthetic-fracture-management-and-fixation","status":"publish","type":"post","link":"https:\/\/www.orthogate.org\/press\/deep-research\/joint-arthroplasty-balancing-innovation-and-evidence\/periprosthetic-fracture-management-and-fixation\/","title":{"rendered":"Periprosthetic Fracture Management and Fixation"},"content":{"rendered":"

Periprosthetic Fractures Around Total Hip and Knee Replacements<\/span><\/span><\/h1>\n

Periprosthetic fractures are breaks in the bone that occur around or near a joint replacement implant. These fractures present a growing concern in orthopedics, with an increasing incidence attributed to factors such as the rising number of joint replacement surgeries performed each year and the aging population<\/span>1<\/sup><\/span>. This article offers a comprehensive overview of periprosthetic fractures around total hip and knee replacements, encompassing their incidence, management, classification, surgical techniques, and implant options.<\/span><\/p>\n

Incidence of Periprosthetic Fractures<\/span><\/span><\/h2>\n

The incidence of periprosthetic fractures can vary based on factors like the type of joint replacement, patient age, bone quality, and implant type. The increasing number of primary total hip arthroplasties performed is expected to lead to a rise in the incidence of periprosthetic fractures around the femoral stem<\/span>2<\/sup><\/span>.<\/span><\/p>\n

Total Hip Replacements<\/span><\/span><\/h3>\n
    \n
  1. Intraoperative fractures occur in 3.5% of primary uncemented hip replacements and 0.4% of cemented arthroplasties<\/span>3<\/sup><\/span>. The mechanism of these fractures typically involves impaction of the acetabular component during surgery<\/span>3<\/sup><\/span>.<\/span><\/li>\n
  2. Postoperative fractures occur in 0.1% of primary THAs, most commonly at the stem tip<\/span>3<\/sup><\/span>.<\/span><\/li>\n
  3. The 20-year fracture probability is 3.5% for primary THA and 11% for revision THA<\/span>4<\/sup><\/span>.<\/span><\/li>\n
  4. The incidence of periprosthetic fractures needing surgery is 0.92 per 1,000 prosthesis years. This incidence is higher in patients over 70 years old at the time of primary THR and for patients who underwent THR for a hip fracture<\/span>5<\/sup><\/span>.<\/span><\/li>\n
  5. In revision hip replacement, the rate of periprosthetic fracture was three times higher with uncemented stems<\/span>4<\/sup><\/span>.<\/span><\/li>\n
  6. Increased use of cementless acetabular cups is predicted to increase the occurrence of future periprosthetic fractures of the acetabulum after THA<\/span>4<\/sup><\/span>.<\/span><\/li>\n<\/ol>\n

    Several risk factors can contribute to periprosthetic femoral fractures after THA, including:<\/span><\/p>\n

      \n
    1. Impaction bone grafting<\/span><\/li>\n
    2. Female gender<\/span><\/li>\n
    3. Technical errors during surgery<\/span><\/li>\n
    4. Cementless implants<\/span><\/li>\n
    5. Osteoporosis<\/span><\/li>\n
    6. Revision surgery<\/span><\/li>\n
    7. Minimally invasive techniques (controversial)<\/span> 3<\/sup><\/span><\/li>\n<\/ol>\n

      The etiology of these fractures can differ depending on the timing of their occurrence:<\/span><\/p>\n

        \n
      1. Early postoperative fractures (within the first six months): Cementless prostheses tend to fracture early, likely due to stress risers created during reaming and broaching. Wedge-fit tapered designs are associated with proximal fractures, while cylindrical fully porous-coated stems tend to cause a distal split in the femoral shaft<\/span>3<\/sup><\/span>.<\/span><\/li>\n
      2. Late postoperative fractures (typically after 5 years): Cemented prostheses tend to fracture later, usually around the tip of the prosthesis or distal to it<\/span>3<\/sup><\/span>.<\/span><\/li>\n<\/ol>\n

        Total Knee Replacements<\/span><\/span><\/h3>\n
          \n
        1. The incidence of femoral periprosthetic fractures after TKA ranges from 0.3% to 2.5% but increases up to 38% in revision TKA cases with supracondylar fractures<\/span>6<\/sup><\/span>.<\/span><\/li>\n
        2. The risk of fracture after primary TKA is 0.6%<\/span> 7<\/sup><\/span> versus 1.7% after revision TKA<\/span>8<\/sup><\/span>. Patients aged 70 years or older are 1.6 times more likely to experience a fracture than younger patients, and women are 2.3 times more likely to suffer a fracture than men<\/span>8<\/sup><\/span>.<\/span><\/li>\n
        3. Periprosthetic fractures of the tibia occur at an incidence of approximately 0.4\u20131.7% in primary TKA and approximately 0.9% in revision TKA<\/span>7<\/sup><\/span>.<\/span><\/li>\n
        4. Periprosthetic fractures of the patella occur with an incidence of 0.2\u201321% of cases, depending on whether patellar resurfacing was performed<\/span>7<\/sup><\/span>.<\/span><\/li>\n
        5. The incidence of intraoperative periprosthetic fracture is likely underestimated, as some fractures may go undetected, and others with minimal displacement may not require further intervention<\/span>9<\/sup><\/span>.<\/span><\/li>\n<\/ol>\n

          Several risk factors can contribute to periprosthetic fractures around TKA, including:<\/span><\/p>\n

            \n
          1. Advanced age<\/span><\/li>\n
          2. Chronic steroid use<\/span><\/li>\n
          3. Inflammatory arthropathy (e.g., rheumatoid arthritis)<\/span><\/li>\n
          4. Neurological diseases (e.g., epilepsy, Parkinson’s disease)<\/span> 7<\/sup><\/span><\/li>\n
          5. Diabetes mellitus, which can affect post-surgical healing and increase the risk of falls<\/span> 6<\/sup><\/span><\/li>\n<\/ol>\n

            Anterior femoral notching during TKA has been implicated as a potential cause of supracondylar fracture<\/span>7<\/sup><\/span>. Notches greater than 3 mm deep, sharper notches, and notches close to the femoral prosthesis can influence local stress concentration, potentially reducing torsional bone strength by 30\u201340% and flexural strength by 18%<\/span>8<\/sup><\/span>. Periprosthetic fractures also occur significantly closer to the prosthesis in patients with anterior notching, which can pose challenges for fracture fixation<\/span>4<\/sup><\/span>.<\/span><\/p>\n

            The age group most affected by aseptic periprosthetic fractures around TKA is between 65 and 75 years old<\/span>6<\/sup><\/span>. Factors associated with an increased risk of femoral supracondylar periprosthetic fractures include female sex, dementia, motor alteration, Parkinson’s disease, and previous femoral overcut<\/span>6<\/sup><\/span>.<\/span><\/p>\n

            Management of Periprosthetic Fractures<\/span><\/span><\/h2>\n

            The management of periprosthetic fractures depends on various factors, including the type and location of the fracture, the quality of the remaining bone, the stability of the implant, and the patient’s overall medical health<\/span>10<\/sup><\/span>. Delaying surgery for these fractures does not increase mortality or complications but can increase the length of hospital stay<\/span>1<\/sup><\/span>.<\/span><\/p>\n

            Total Hip Replacements<\/span><\/span><\/h3>\n

            Most cases of periprosthetic hip fractures require surgery<\/span>10<\/sup><\/span>. Postoperative periprosthetic femoral fracture (POPFF) after total hip replacement (THR) is a significant complication and the most common reason for major reoperation following THR. Patients with POPFF also have a high risk of death<\/span>5<\/sup><\/span>. The general approaches to treating these fractures include:<\/span><\/p>\n

              \n
            1. Open reduction and internal fixation (ORIF)<\/span><\/li>\n
            2. Revision of the total hip replacement with an exchange of some or all of the implants<\/span><\/li>\n
            3. A combination of both<\/span> 10<\/sup><\/span><\/li>\n<\/ol>\n

              Managing periprosthetic hip fractures can be challenging due to factors such as multiple bone fragments, poor bone quality, and the presence of bone cement<\/span>11<\/sup><\/span>. Revision surgery for periprosthetic femur fractures is associated with a high rate of complications, including malunion, nonunion, implant failure, and infection<\/span>12<\/sup><\/span>.<\/span><\/p>\n

              Postoperative care and recovery after periprosthetic hip fracture surgery typically involve:<\/span><\/p>\n

                \n
              1. Pain management<\/span><\/li>\n
              2. Rehabilitation, often including physical therapy<\/span><\/li>\n
              3. Restricted weight-bearing for a specified period<\/span><\/li>\n
              4. Activity limitations to avoid strenuous activities and heavy lifting<\/span><\/li>\n
              5. Regular follow-up appointments to monitor progress<\/span> 11<\/sup><\/span><\/li>\n<\/ol>\n

                Total Knee Replacements<\/span><\/span><\/h3>\n

                Identifying the cause of the fracture is crucial in determining the appropriate therapy for periprosthetic knee fractures<\/span>13<\/sup><\/span>. Conservative treatment, such as casting or bracing, may be an option for undisplaced fractures with a stable prosthesis<\/span>14<\/sup><\/span>. However, conservative treatment often requires a prolonged period of immobility, which can pose risks to the patient, such as deep vein thrombosis, pulmonary embolism, and other complications associated with prolonged bed rest<\/span>14<\/sup><\/span>.<\/span><\/p>\n

                Classification of Periprosthetic Fractures<\/span><\/span><\/h2>\n

                Several classification systems are used to categorize periprosthetic fractures, which can help guide treatment planning and provide prognostic information.<\/span><\/p>\n

                Total Hip Replacements<\/span><\/span><\/h3>\n

                The<\/span> Vancouver classification system<\/b><\/span> is the most widely used system for periprosthetic hip fractures<\/span>15<\/sup><\/span>. This system considers the fracture location, prosthesis stability, and bone quality to guide treatment decisions<\/span>12<\/sup><\/span>. It is important to verify the stability of the femoral component intraoperatively to ensure the correct treatment approach is taken<\/span>12<\/sup><\/span>.<\/span><\/p>\n\n\n\n\n\n\n\n
                Type<\/b><\/span><\/th>\nDescription<\/b><\/span><\/th>\n<\/tr>\n<\/thead>\n
                Type A<\/span><\/td>\nFractures of the greater (AG) or lesser (AL) trochanters<\/span><\/td>\n<\/tr>\n
                Type B<\/span><\/td>\nFractures involving the femoral diaphysis and\/or metaphysis around the femoral stem. These are subdivided into:
                – B1: Stable stem
                – B2: Loose stem but good bone stock
                – B3: Loose stem and poor bone stock<\/span><\/td>\n<\/tr>\n
                Type C<\/span><\/td>\nFractures well distal to the tip of the femoral stem<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                The<\/span> Unified Classification System (UCS)<\/b><\/span> has been proposed as a standardized system for classifying periprosthetic fractures around various joints, including the hip and knee<\/span>16<\/sup><\/span>. It offers a consistent framework for describing these fractures and guiding their management. The UCS classifies fractures based on their location relative to the implant and includes the following types:<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n
                Type<\/b><\/span><\/th>\nDescription<\/b><\/span><\/th>\n<\/tr>\n<\/thead>\n
                Type A<\/span><\/td>\nFracture of an apophysis or bone protuberance (e.g., greater trochanter)<\/span><\/td>\n<\/tr>\n
                Type B<\/span><\/td>\nFracture in the bed of the implant or adjacent to it
                – B1: Well-fixed implant
                – B2: Loose implant
                – B3: Loose implant with poor bone quality<\/span><\/td>\n<\/tr>\n
                Type C<\/span><\/td>\nFracture distant from the implant<\/span><\/td>\n<\/tr>\n
                Type D<\/span><\/td>\nInterprosthetic fracture between two implants<\/span><\/td>\n<\/tr>\n
                Type E<\/span><\/td>\nFracture involving both bones supporting the implant<\/span><\/td>\n<\/tr>\n
                Type F<\/span><\/td>\nFracture of a bone articulating with a hemiarthroplasty<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                Total Knee Replacements<\/span><\/span><\/h3>\n

                Several classification systems are used for periprosthetic fractures around total knee replacements, including the<\/span> Neer<\/b><\/span>,<\/span> DiGioia and Rubash<\/b><\/span>,<\/span> Chen<\/b><\/span>,<\/span> Lewis and Rorabeck<\/b><\/span>, and<\/span> Su<\/b><\/span> classifications<\/span>17<\/sup><\/span>. These systems typically consider factors such as fracture displacement, implant stability, and bone quality.<\/span><\/p>\n

                Patella<\/b><\/span><\/p>\n

                Periprosthetic patellar fractures are classified based on component stability, bone stock quality, and the integrity of the extensor mechanism<\/span>14<\/sup><\/span>. The<\/span> Goldberg<\/b><\/span> and<\/span> Ortiguera and Berry<\/b><\/span> classifications are commonly used for these fractures<\/span>17<\/sup><\/span>.<\/span><\/p>\n

                Surgical Techniques for Fracture Fixation<\/span><\/span><\/h2>\n

                Surgical intervention for periprosthetic fractures aims to achieve early mobilization, restore axial alignment, and stabilize the limb to allow for joint motion and prevent stiffness<\/span>18<\/sup><\/span>.<\/span><\/p>\n

                Total Hip Replacements<\/span><\/span><\/h3>\n

                Surgical techniques for periprosthetic hip fractures often involve a combination of revision arthroplasty and trauma techniques to address loose prostheses, bone loss, and the fracture itself<\/span>19<\/sup><\/span>. It is crucial to assess the stability of the femoral component intraoperatively to guide the treatment rationale<\/span>20<\/sup><\/span>.<\/span><\/p>\n

                Common surgical techniques include:<\/span><\/p>\n

                  \n
                1. ORIF with cables, plates, and screws<\/span> 10<\/sup><\/span><\/li>\n
                2. Revision of the femoral component to a longer stem prosthesis<\/span> 3<\/sup><\/span><\/li>\n
                3. Use of cortical strut allografts for added stability<\/span> 3<\/sup><\/span><\/li>\n<\/ol>\n

                  Minimally invasive surgical techniques are increasingly used for periprosthetic femur fractures, as they can shorten operative time, reduce bleeding, and minimize fracture exposure<\/span>20<\/sup><\/span>.<\/span><\/p>\n

                  Total Knee Replacements<\/span><\/span><\/h3>\n

                  Surgical techniques for periprosthetic knee fractures include:<\/span><\/p>\n

                    \n
                  1. ORIF with plates and screws<\/span> 22<\/sup><\/span><\/li>\n
                  2. Intramedullary nailing<\/span> 22<\/sup><\/span><\/li>\n
                  3. Revision total knee replacement with larger implants and stems for stability<\/span> 22<\/sup><\/span><\/li>\n
                  4. Distal femoral replacement in cases with insufficient bone at the end of the femur<\/span> 22<\/sup><\/span><\/li>\n<\/ol>\n

                    The cause of the fracture and the fixation of the components must be considered when managing periprosthetic fractures around TKA<\/span>13<\/sup><\/span>.<\/span><\/p>\n

                    Implant Options for Fracture Fixation<\/span><\/span><\/h2>\n

                    Total Hip Replacements<\/span><\/span><\/h3>\n

                    Implant options for periprosthetic hip fractures include:<\/span><\/p>\n

                      \n
                    1. Screws and plates for ORIF<\/span><\/li>\n
                    2. Cables and wires for cerclage fixation<\/span><\/li>\n
                    3. Longer stems for revision surgery<\/span><\/li>\n
                    4. Allograft bone to supplement weak or missing bone<\/span> 10<\/sup><\/span><\/li>\n<\/ol>\n

                      It can be challenging to determine implant loosening with plain radiographs, and computed tomography (CT) scans may be necessary to identify debonding, cement mantle disruption, and osteolysis<\/span>23<\/sup><\/span>.<\/span><\/p>\n

                      Comparison of Surgical Techniques and Implant Options<\/span><\/span><\/h2>\n

                      The choice between ORIF and revision arthroplasty for periprosthetic fractures depends on several factors, including fracture location, implant stability, and bone quality<\/span>10<\/sup><\/span>. ORIF is generally preferred for fractures around a well-fixed stem, while revision arthroplasty is often necessary for fractures around a loose stem or with poor bone stock<\/span>20<\/sup><\/span>.<\/span><\/p>\n

                      Studies comparing ORIF with revision surgery for periprosthetic femoral fractures have shown that revision surgery can have higher reoperation rates, longer surgical waiting times, and higher transfusion requirements<\/span>24<\/sup><\/span>. However, ORIF of Vancouver type-B3 periprosthetic femoral fractures has been associated with higher revision and reoperation rates than revision arthroplasty<\/span>25<\/sup><\/span>.<\/span><\/p>\n

                      Different implant options are available for fracture fixation, including plates, screws, cables, and allografts<\/span>3<\/sup><\/span>. Locking plates offer advantages in terms of stability, especially in osteoporotic bone, but may be associated with a higher rate of nonunion<\/span>26<\/sup><\/span>. Cerclage wires used with locking plate fixation have been shown to be effective in treating periprosthetic fractures of the femur, with faster time to union and fewer revisions<\/span>27<\/sup><\/span>.<\/span><\/p>\n

                      Outcomes of Surgical Treatment<\/span><\/span><\/h2>\n

                      The outcomes of surgical treatment for periprosthetic fractures can vary depending on the chosen technique and implant<\/span>28<\/sup><\/span>. Fracture union rates are generally high, but complications such as infection, nonunion, and implant failure can occur<\/span>26<\/sup><\/span>. Periprosthetic fractures are associated with a high morbidity and mortality, emphasizing the need for comprehensive management<\/span>14<\/sup><\/span>.<\/span><\/p>\n

                      Factors that can influence outcomes include:<\/span><\/p>\n

                        \n
                      1. Patient age and comorbidities<\/span><\/li>\n
                      2. Bone quality<\/span><\/li>\n
                      3. Fracture type and location<\/span><\/li>\n
                      4. Implant stability<\/span><\/li>\n
                      5. Surgical technique<\/span> 10<\/sup><\/span><\/li>\n<\/ol>\n

                        Recent Advances in Periprosthetic Fracture Management<\/span><\/span><\/h2>\n

                        Recent advances in periprosthetic fracture management include:<\/span><\/p>\n

                          \n
                        1. Development of specialized periprosthetic screws and variable angle screws and locking plates<\/span> 21<\/sup><\/span><\/li>\n
                        2. Increased use of minimally invasive techniques<\/span> 26<\/sup><\/span><\/li>\n
                        3. Improved understanding of implant options and their biomechanical properties<\/span> 29<\/sup><\/span><\/li>\n<\/ol>\n

                          These advancements have led to more flexible and stable fixation options, reduced surgical morbidity, and improved patient outcomes.<\/span><\/p>\n

                          Conclusion<\/span><\/span><\/h2>\n

                          Periprosthetic fractures are a significant concern in orthopedic surgery, with an increasing incidence due to the aging population and the growing number of joint replacement procedures performed. These fractures can be challenging to manage due to factors such as poor bone quality, implant loosening, and the complexity of the surgical procedures involved.<\/span><\/p>\n

                          This article has provided a comprehensive overview of periprosthetic fractures around total hip and knee replacements, including their incidence, classification, management, surgical techniques, and implant options. Several key takeaways from this review include:<\/span><\/p>\n

                            \n
                          1. Early diagnosis and appropriate treatment are essential to minimize complications and optimize patient outcomes.<\/span><\/li>\n
                          2. The Vancouver classification system is a valuable tool for guiding treatment decisions for periprosthetic hip fractures.<\/span><\/li>\n
                          3. A variety of surgical techniques and implant options are available, and the choice depends on individual patient factors and fracture characteristics.<\/span><\/li>\n
                          4. Recent advances in surgical techniques, implant design, and minimally invasive approaches have improved the management of these complex injuries.<\/span><\/li>\n<\/ol>\n

                            Ongoing research is crucial to further enhance our understanding of periprosthetic fractures, improve treatment strategies, and develop innovative solutions to address this growing challenge in orthopedics.<\/span><\/p>\n

                            Works cited<\/span><\/h4>\n

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                            2. Periprosthetic Fracture around a Cemented Stem in Total Hip Arthroplasty, accessed February 17, 2025, https:\/\/www.hipandpelvis.or.kr\/journal\/view.html?doi=10.5371\/hp.2022.34.3.140<\/a><\/p>\n

                            3. THA Periprosthetic Fracture – Recon – Orthobullets, accessed February 17, 2025, https:\/\/www.orthobullets.com\/recon\/5013\/tha-periprosthetic-fracture<\/a><\/p>\n

                            4. Periprosthetic and Peri-implant Fractures: Practice Essentials, Pathophysiology, Etiology, accessed February 17, 2025, https:\/\/emedicine.medscape.com\/article\/1269334-overview<\/a><\/p>\n

                            5. The incidence of postoperative periprosthetic femoral fracture following total hip replacement: An analysis of UK National Joint Registry and Hospital Episodes statistics data – PubMed, accessed February 17, 2025, https:\/\/pubmed.ncbi.nlm.nih.gov\/39352892\/<\/a><\/p>\n

                            6. KNEE PERIPROSTHETIC FRACTURES IN THE ELDERLY: CURRENT CONCEPT, accessed February 17, 2025, https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/38566-knee-periprosthetic-fractures-in-the-elderly-current-concept<\/a><\/p>\n

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                            8. Periprosthetic fractures around total knee arthroplasty | The Annals of The Royal College of Surgeons of England, accessed February 17, 2025, https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/003588412X13171221592537<\/a><\/p>\n

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                            10. Fracture After Total Hip Replacement – OrthoInfo – AAOS, accessed February 17, 2025, https:\/\/orthoinfo.aaos.org\/en\/diseases–conditions\/fracture-after-total-hip-replacement\/<\/a><\/p>\n

                            11. Periprosthetic Hip Fracture Management Westminster – Dr Ian Weber, accessed February 17, 2025, https:\/\/www.drianweber.com\/periprosthetic-hip-fracture-management-orthopaedic-surgeon-westminster-co\/<\/a><\/p>\n

                            12. In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures – PMC, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3069264\/<\/a><\/p>\n

                            13. Periprosthetic fracture management around total knee arthroplasty – PMC – PubMed Central, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7876523\/<\/a><\/p>\n

                            14. Periprosthetic fractures around the knee: current concepts and advances in management, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4092206\/<\/a><\/p>\n

                            15. Periprosthetic and Peri-implant Fractures Workup – Medscape Reference, accessed February 17, 2025, https:\/\/emedicine.medscape.com\/article\/1269334-workup<\/a><\/p>\n

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                            20. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls – PMC, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4598449\/<\/a><\/p>\n

                            21. Periprosthetic fractures, management of the hip and the knee – AO Foundation, accessed February 17, 2025, https:\/\/www.aofoundation.org\/trauma\/about-aotrauma\/blog\/2024_01-blog-periprosthetic-fractures-hip-and-knee<\/a><\/p>\n

                            22. Fracture After Total Knee Replacement – OrthoInfo – AAOS, accessed February 17, 2025, https:\/\/orthoinfo.aaos.org\/en\/diseases–conditions\/fracture-after-total-knee-replacement\/<\/a><\/p>\n

                            23. Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes – PubMed Central, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7528669\/<\/a><\/p>\n

                            24. A multicentre comparative analysis of fixation versus revision surgery for periprosthetic femoral fractures following total hip arthroplasty with a cemented polished taper-slip femoral component – PubMed, accessed February 17, 2025, https:\/\/pubmed.ncbi.nlm.nih.gov\/36722066\/<\/a><\/p>\n

                            25. Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures – PubMed, accessed February 17, 2025, https:\/\/pubmed.ncbi.nlm.nih.gov\/34415859\/<\/a><\/p>\n

                            26. Management of peri-prosthetic fractures around total hip arthroplasty: a contemporary review of surgical options – Annals of Joint, accessed February 17, 2025, https:\/\/aoj.amegroups.org\/article\/view\/4492\/html<\/a><\/p>\n

                            27. Locking Plate Fixation of Periprosthetic Femur Fractures with and without Cerclage Wires, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6583122\/<\/a><\/p>\n

                            28. Outcomes following surgical treatment of periprosthetic femur fractures: a single centre series – PMC, accessed February 17, 2025, https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4035404\/<\/a><\/p>\n

                            29. Treatment of Periprosthetic Femoral Fractures Following Total Hip Arthroplasty with Femoral Component Revision – Orthobullets, accessed February 17, 2025, https:\/\/upload.orthobullets.com\/journalclub\/free_pdf\/14630846.pdf<\/a><\/p>","protected":false},"excerpt":{"rendered":"

                            Periprosthetic Fractures Around Total Hip and Knee Replacements Periprosthetic fractures are breaks in the bone that occur around or near a joint replacement implant. These fractures present a growing concern in orthopedics, with an increasing incidence attributed to factors such as the rising number of joint replacement surgeries performed each year and the aging population1. […]<\/p>\n","protected":false},"author":1,"featured_media":5320,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[527],"tags":[658,662,660,661,597,581,657,659,656],"class_list":["post-5282","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-joint-arthroplasty-balancing-innovation-and-evidence","tag-fracture-fixation","tag-implant-options","tag-orif","tag-periprosthetic-fracture","tag-revision-surgery","tag-surgical-techniques","tag-total-hip-replacement","tag-total-knee-replacement","tag-vancouver-classification"],"_links":{"self":[{"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/posts\/5282","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/comments?post=5282"}],"version-history":[{"count":0,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/posts\/5282\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/media\/5320"}],"wp:attachment":[{"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/media?parent=5282"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/categories?post=5282"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.orthogate.org\/press\/wp-json\/wp\/v2\/tags?post=5282"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}