A JBJS review by arthroplasty and registry researchers sets out the case that periprosthetic femoral fractures after total hip arthroplasty are an emerging surgical emergency. Registry projections suggest their absolute number will rise substantially as more primary hip replacements are done and those patients age.
The consequences are severe. Mortality after a periprosthetic fracture is comparable to that after a hip fragility fracture, reoperation rates are high, and implant survival after fixation is substantially reduced. The authors argue that prevention should be part of the plan at the primary operation, not an afterthought when the fracture arrives.
The review focuses on fractures of the proximal femur around a hip stem, their mechanisms and classification, and calls for a holistic, multidisciplinary approach. In practice that means treating the arthroplasty patient as someone at fracture risk: assessing bone health and falls, and considering how implant choice affects risk in older patients with poor bone. Registry data have linked cemented femoral fixation with a lower risk of early periprosthetic fracture in older patients, which is one of the choices the review asks surgeons to weigh.
This is a narrative review rather than new data, but the direction is clear: the patient with a hip replacement is a fracture patient in waiting, and should be managed as one.
- Assess bone health and falls risk before primary hip arthroplasty in older patients.
- Weigh stem fixation choice against bone quality, particularly in older women with osteoporosis.
- Refer patients with a hip replacement and a fragility fracture history to a fracture liaison or bone health service.
- Treat a periprosthetic fracture with the same urgency and orthogeriatric input as a hip fragility fracture.
- Ask about falls at arthroplasty follow-up, not only about the joint.
Why it matters
The mortality of these fractures matches that of hip fragility fractures, yet they rarely get the same preventive pathway.
Don't overread it
This is a narrative review; it argues for prevention but does not test any single preventive measure.
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