What is a periprosthetic fracture?
This is where a fracture occurs through the bone around a hip or a knee replacement implant.
What can cause them?
Periprosthetic fractures are certainly on the rise now and in certain parts of Europe, they are the second commonest cause of revision surgery. The causes include significant trauma following a fall, even around well-fixed and well-positioned implants. Other causes can include trauma around implants which are not so well fixed or positioned and have become loose with the passage of time.
The presentation is often quite dramatic following a fall or even a fracture around the implant.
What investigations may be required?
Since patients often present in quite a dramatic fashion, in the acute situation, the advance trauma life support protocol is followed to exclude any life-threatening injuries before attention is turned to the limb and prosthesis.
Can the problem get worse?
Certain configurations in which the implant remains well-fixed and there is minimal bony involvement can be managed with a period of protected weight bearing and radiological surveillance.
The vast majority of cases do require either operative stabilisation if there is significant bony involvement around a well-fixed implant, or even revision surgery if the implant is obviously loose. In certain situations where there is significant bony involvement, a massive endoprosthetic replacement comprising either a distal femoral or a proximal femoral replacement may be required.