This JBJS current-concepts review, published 22 September, examines periprosthetic proximal femoral fractures after total hip replacement. National registry projections show the absolute number will rise substantially as primary arthroplasty volume grows and people with implants age.
The consequences are severe. Mortality after a periprosthetic fracture rivals that after a hip fragility fracture, reoperation rates are high, and implant survival after fixation is substantially reduced. The authors argue that prevention must be treated as part of arthroplasty care, not a separate problem that appears years later in the trauma list.
In practice that means thinking at the time of the primary operation about bone quality, stem choice and fixation in older, osteoporotic patients, and afterwards about falls and bone protection. The review is expert synthesis rather than new trial data, but it reframes a late complication as a modifiable one.
- Assess bone quality and fracture risk before every primary hip replacement in older patients.
- Consider stem design and fixation choice in osteoporotic bone to reduce later fracture risk.
- Start or refer for osteoporosis treatment after arthroplasty in patients at risk.
- Include falls assessment and prevention in post-arthroplasty follow-up.
Why it matters
Moves responsibility for a growing, lethal fracture from the trauma surgeon years later to the arthroplasty surgeon now.
Don't overread it
This is a narrative review; it identifies the problem and priorities but does not test any prevention strategy.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free