Published: 2022-10-27

The management of complex periprosthetic femoral fractures: a case series of plating with wire augmentation, and a review of the literature

Neetin P. Mahajan, Kunal Chaudhari, Ravi Patel, Pramod Bagimani, Akshay Gund


Periprosthetic fractures continue to increase in frequency. This is due, in part, to the increasing number of primary and revision arthroplasties performed annually and to the increasing age and fragility of patients with such implants. All types of periprosthetic fractures can present unique and substantial treatment challenges. Here we present a case series of 3 elderly patients who came to us with periprosthetic hip fractures in previously operated case of hip hemiarthroplasty/total hip replacement done. The injuries were managed with splintage and operative procedures. Postoperatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Periprosthetic fractures are becoming quite common in elderly and difficult to treat as the number of hip joint arthroplasty operative has increased in developing countries. the correct procedure is very challenging as every case needs to be treated very individualistically. A good plan always results in much reduction in the operating time and better patient post operative outcome. Postoperatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. So that early appropriate treatment and mobilization can be done with good functional outcome.


Periprosthetic fractures, Ipsilateral, Hip trauma, Upper limb trauma, Hemiarthroplasty, Arthroplasty

Full Text:



Horwitz IB, Lenobel MI. Artificial hip prosthesis in acute and nonunion fractures of the femoral neck: follow-up study of seventy cases. J Am Med Assoc. 1954;155(6):564-7.

Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30(2):183-90.

Berry DJ. Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplasty. 2003;18(31):107-11.

Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty. Treatment and results to date. J Bone Joint Surg Am. 1997;79(12):1881-90.

Lewallen DG, Berry DKJ. Femoral fractures associated with hip arthroplasty. In: Morrey BF, editor. Reconstructive surgery of the joints. New York: Churchill-Livingstone. 1996;1273-88.

Johansson JE, McBroom R, Barrington TW, Hunter GA. Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg [Am]. 1981;63-A:1435-42.

Bethea JS 3rd, DeAndrade JR, Fleming LL, Lindenbaum JD, Welch RB. Proximal femoral fractures following total hip arthroplasty. Clin Orthop. 1982;170:95-106.

Curral V, Thomason K, Eastaugh-Waring S, Ward AJ, Chesser TJS. The use of LISS femoral locking plates and cabling in the treatment of periprosthetic fractures around stable proximal femoral implants in elderly patients. Hip Int. 2008;18:207-11.

Chakravarthy J, Bansal R, Cooper J. Locking plate osteosynthesis for Vancouver type B1 and type C periprosthetic fractures of femur: A report on 12 patients. Injury. 2007;38:725-33.

Kumar V, Kanabar P, Owen PJ, Rushton N. Less Invasive Stabilization System for the management of periprosthetic femoral fractures around hip arthroplasty. J Arthroplasty. 2008;23:446-50.

Fulkerson E, Tejwani N, Stuchlin S, Egol K. Management of periprosthetic femur fractures with a first-generation locking plate. Injury. 2007;38:965-72.