PERIPROSTHETIC FRACTURE OF THE HIP

Abstract

Periprosthetic fractures of the hip are serious complications following total hip arthroplasty, particularly affecting elderly patients, those with osteoporosis, or individuals with a history of revision surgeries. These fractures may occur intraoperatively or postoperatively, involving the femoral shaft (classified as Vancouver A, B, or C) or the acetabulum (Paprosky classification). Acetabular fractures are less common than femoral fractures. The mechanisms of fracture involve both biological factors (such as stress risers, implant loosening, and poor bone quality) and external forces (such as falls, torsional, and bending loads). Identified risk factors include advanced age, female gender, osteoporosis, implant loosening, use of cementless femoral stems, rheumatoid arthritis, and multiple revision surgeries. Studies have reported the incidence of periprosthetic fractures after primary hip replacement ranging from 0.8% to 4.5%, with higher rates observed following revision procedures. Diagnosis relies on both clinical and paraclinical assessments, with plain radiographs and computed tomography (CT) being the primary tools to evaluate implant stability, bone loss, and to guide treatment planning. Treatment depends on the type of fracture and the stability of the prosthesis. Stable Vancouver A fractures may be managed conservatively; Vancouver B1 fractures often require internal fixation with plates and screws; B2 and B3 fractures typically necessitate revision with a long-stem prosthesis and bone grafting if needed. Nondisplaced acetabular fissure fractures may be treated conservatively, but displaced or unstable fractures require surgical reconstruction using plates, screws, bone grafts, or specialized acetabular components. Prognosis is influenced by patient age, the severity of osteoporosis, prosthesis stability, and the number of prior surgeries. The mortality rate following periprosthetic hip fractures ranges from 7% to 18% within the first year postoperatively. Prevention, thorough risk assessment, and appropriate treatment strategies play crucial roles in improving clinical outcomes.