Periprosthetic fracture fixation is an operation to stabilise a fracture occurring around or near an existing joint replacement — most commonly around hip or knee replacements. Treatment depends on whether the implant is still well-fixed or has loosened.
Treatment depends on the fracture location and implant stability. If the implant is well-fixed: the fracture is fixed around the existing prosthesis using a plate, cerclage wires, or cables. If the implant is loose: the implant is revised (replaced) with a longer-stemmed prosthesis that bypasses the fracture, combined with fixation of the fracture fragments. The operation takes one and a half to three hours depending on complexity.
Periprosthetic fractures almost always require surgery. They are increasingly common as more patients live with joint replacements and the population ages. Falls are the most common cause.
Very rarely appropriate. Non-operative management may be considered for undisplaced fractures around well-fixed implants in patients who are not fit for surgery, with strict activity restrictions.
Full-length X-rays of the affected bone and implant. CT may help assess implant fixation and fracture configuration. Previous operative notes help identify the implant type and size. The correct revision implants must be available.
Stabilisation allowing mobilisation. Outcomes depend on the patient's overall health and the complexity of the fracture-implant combination. Healing rates are lower than standard fractures due to the altered biology around implants.
Fractures around implants often heal more slowly than standard fractures.
Many patients are elderly with significant comorbidities.
Significant. Transfusion often needed.
Recovery is slower than for a primary fracture or primary joint replacement.
Higher risk than standard fractures, approximately 10–15%.
The plate, wires, or revised prosthesis may fail.
Higher risk than primary fracture fixation, approximately 3–5%.
If revision arthroplasty is performed.
Elderly patients with periprosthetic fractures have significant one-year mortality.
Risk of fracture at another level around the implant.
General or spinal anaesthesia. These patients often have significant medical comorbidities requiring careful optimisation.
Weight-bearing depends on the fracture pattern, fixation, and implant. Protected weight-bearing for six to twelve weeks is common. Physiotherapy essential. Many patients require inpatient rehabilitation. Recovery to pre-fracture function is the goal but not always achievable.
X-rays at six weeks, three months, and six months. Regular monitoring of both the fracture and the implant.
The implant occupies the bone canal, limiting fixation options. The bone around implants is often weakened by stress shielding. The biology of healing is altered. These factors make periprosthetic fractures more complex than standard fractures.
If the implant is well-fixed and undamaged, it can often be retained. If it has loosened, revision to a longer-stemmed prosthesis is needed. The replacement usually continues to function well after the fracture heals.