Emergency: requires immediate attention
Total hip arthroplasty periprosthetic fracture
Alerts and Notices
Synopsis
Causes / typical injury mechanism: Total hip arthroplasty (THA) periprosthetic fractures are rare, occurring in approximately 0.1%-3% of all cementless THAs. The most common cause of THA periprosthetic fractures is minor trauma (87%), particularly low-energy falls, followed by spontaneous fracture (9%) and major trauma (4%). The large majority of these fractures occur at the femur, but acetabular fractures may also occur.Classic history and presentation: The condition presents as pain, swelling, or bruising over the hip or thigh, particularly during weight-bearing and hip mobilization. A lower limb length discrepancy may be present, with the affected limb appearing shorter. Patient history includes THA and often involves a recent fall.
Prevalence: The occurrence of postoperative THA periprosthetic fracture has been estimated as up to 3%-4% following a primary hip arthroplasty and up to 12% following a revision hip arthroplasty.
- Age – Postoperative THA periprosthetic fractures most commonly occur in patients of advanced age due to association with other comorbidities, such as osteoporosis, and increased likelihood of falls. However, younger patients with an active lifestyle are also at an increased risk.
- Sex / gender – This condition can occur in either sex but is more common in females due to increased bone degeneration with age.
- Osteoporosis
- Rheumatoid arthritis
- Advanced age
- Posttraumatic osteoarthritis
- Proximal femoral deformities
- Prior ipsilateral hip surgery
- Trauma
- Osteolysis
- Stem loosening with associated osteolysis
- Revision THAs
Grade / classification system: The Vancouver classification system is a validated method for guiding treatment of postoperative periprosthetic femoral fractures based on location of the fracture, stability of prosthesis, and surrounding bone quality. Type A fractures involve either the greater (AG) or lesser (AL) trochanter. Type B fractures occur around or just below the stem, and are divided into B1, B2, and B3, depending on surrounding bone quality and implant stability, with B1 having a well-fixed stem, B2 having an unstable stem with good surrounding bone quality, and B3 having an unstable prosthesis and poor proximal bone quality. Type C fractures occur distal to a stable implant and stem.
Codes
ICD10CM:M97.01XA – Periprosthetic fracture around internal prosthetic right hip joint, initial encounter
M97.02XA – Periprosthetic fracture around internal prosthetic left hip joint, initial encounter
SNOMEDCT:
15970001000004108 – Periprosthetic fracture of hip
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Femoral neck stress fracture
- Avascular necrosis of femoral heads (prior to learning patient history)
- Traumatic hip dislocation
- THA dislocation
- Insufficiency fracture related to bisphosphonate use
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:07/26/2021
Last Updated:05/19/2022
Last Updated:05/19/2022
Emergency: requires immediate attention
Total hip arthroplasty periprosthetic fracture