Periprosthetic fracture

Last revised by Evangeline Collins on 11 Sep 2024

Periprosthetic fracture is a term used to describe any fracture that occurs around an implanted orthopedic prosthesis, most commonly knee or hip arthroplasties.

Periprosthetic fractures complicate, ~1% of total hip arthroplasties and ~1.5% of total knee arthroplasties 1,2 although other evidence suggests incidence can range with primary total hip arthroplasty (THA) ranging from 0.1 to 18%, total knee arthroplasty around 0.3 to 5.5%, and total shoulder arthroplasty around 0.5 to 3% 3

Periprosthetic fractures can also be intra-operative with an incidence of around 1.7% for primary THA versus 3.5% at 2- years 3

They can be difficult to diagnose, with metalware potentially obscuring the fracture on an x-ray or creating extensive artifact on CT/MRI.

In the case of hip and knee arthroplasty, it is important to evaluate implant fixation for loosening or subsidence as well as to assess bone stock. The position of the fracture and stability of the implant should be assessed. 

Cases and figures

  • Case 1: involving the hip
  • Case 2: involving the knee
  • Case 3
  • Case 4: Vancouver B1 periprosthetic hip fracture
  • Case 5: periprosthetic hip fracture
  • Case 6
  • Case 7
  • Case 8: with extraosseous cement
  • Case 9: TEA with loosening and fracture
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