The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hip

Periprosthetic Fracture

A periprosthetic fracture is a broken bone occurring at or near a hip or knee replacement implant. These injuries combine the complexity of fracture management with the unique challenges posed by the presence of a prosthesis — existing hardware, altered bone stock, and the need to assess implant stability all factor into treatment decisions. Periprosthetic fractures are increasing in incidence as the aging population accumulates more joint replacements. They represent some of the most demanding reconstructive problems in orthopedic surgery. Maryland Orthopedic Specialists has the expertise in both fracture fixation and revision arthroplasty to manage these injuries comprehensively.

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What is periprosthetic fracture?

Periprosthetic fractures occur most commonly around total hip replacements (femoral stem fractures) and total knee replacements (distal femur fractures above the implant). Risk factors include osteolysis, osteoporosis, falls, implant stress-risers (tip of the femoral stem or distal component), and prior revision surgery.

Periprosthetic fractures occur most commonly around total hip replacements (femoral stem fractures) and total knee replacements (distal femur fractures above the implant). Risk factors include osteolysis, osteoporosis, falls, implant stress-risers (tip of the femoral stem or distal component), and prior revision surgery.

Symptoms — do you recognize these?

  • Sudden onset of severe pain in the hip or knee area, typically after a fall or low-energy injury
  • Inability to bear weight on the affected limb
  • Swelling and ecchymosis (bruising) around the fracture site
  • Deformity or shortening of the limb in displaced fractures
  • Occasionally, a pre-existing dull ache (suggestive of implant loosening) followed by acute fracture

> Call us at (301) 515-0900 — same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

  • Plain X-rays: AP and lateral views of the full femur (hip and knee on one film), AP pelvis, and lateral hip are essential. Identify fracture pattern, location relative to the implant, and implant stability.
  • CT scan: Characterizes fracture pattern in three dimensions; determines implant stability; evaluates bone stock for planning fixation or revision.
  • Implant identification: Manufacturer, model, and size of the existing implant must be identified to plan compatible revision components if needed.
  • Infection workup: ESR, CRP, and joint aspiration are obtained when loosening was present pre-injury or infection is suspected, as these affect treatment strategy.

Treatment options

Periprosthetic Hip Fractures — Vancouver Classification

The most widely used system for classifying fractures around hip replacements:

Periprosthetic Distal Femur Fractures Around TKA

Fractures of the distal femur above a total knee replacement are classified by fracture pattern and implant stability:

Periprosthetic Tibia Fractures

Less common than distal femur fractures. Well-fixed tibial components — ORIF with plate or nail. Loose tibial components — revision arthroplasty.

Surgical Procedure

Revision Hip Arthroplasty

Surgical revision of a failed hip replacement, addressing worn components, loosening, instability, or periprosthetic infection. Requires specialized revision implant systems and reconstruction techniques beyond primary replacement.

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Revision Total Knee Replacement

Complex re-operation to address worn, loose, unstable, or infected knee replacement components. Requires modular augments, intramedullary stems, and increased constraint levels matched to the degree of bone and ligament deficiency.

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Recovery & rehabilitation

Recovery varies with the complexity of treatment:

  • ORIF (stable implant): Protected weight-bearing for 6–12 weeks while fracture heals; gradual return to full weight-bearing; physical therapy throughout.
  • Revision with long stem (B2): Weight-bearing as tolerated, often immediate; PT begins early.
  • Major reconstruction (B3 / distal femoral replacement): More prolonged rehabilitation — 3–6 months to maximum function; some residual limitation expected with massive bone loss.

Frequently Asked Questions

Why does a periprosthetic fracture need a specialist?
These injuries sit at the intersection of fracture surgery and joint replacement revision. Choosing between ORIF and revision — and selecting the right implants — requires expertise in both disciplines. Errors in classification or treatment lead to fixation failure, malunion, or implant loosening.
My fracture is not near the implant tip — do I still need a joint replacement surgeon?
Not always for Type C fractures, but the presence of any joint replacement implant and the need for careful implant assessment make evaluation by an Adult Reconstruction surgeon appropriate.
How is a periprosthetic fracture treated, and will I need surgery?
Most periprosthetic fractures require surgical treatment because the implant makes reliable healing with a cast or brace very difficult. Depending on the fracture pattern and the stability of the existing implant, treatment options include fixation with plates and screws around the implant, or revision to a longer-stemmed implant that bypasses the fracture. Non-surgical management is considered only in patients who are not candidates for anesthesia or in undisplaced fractures where the implant remains solidly fixed. Your MOS surgeon will evaluate imaging and implant stability to determine the safest and most durable approach.
How long does recovery take after a periprosthetic fracture?
Recovery after surgical treatment of a periprosthetic fracture typically takes three to six months, depending on fracture complexity and the patient's bone quality. Weight-bearing restrictions are common in the early weeks to protect the repair while bone healing begins. Physical therapy is essential to restore strength and function, and your MOS team will guide you through each stage. Older patients and those with osteoporosis may require a longer protected period before full weight-bearing is permitted.
What can I do to reduce my risk of a periprosthetic fracture in the future?
After treatment, several steps can lower the risk of a future periprosthetic fracture. Treating osteoporosis with medication, adequate calcium and vitamin D, and appropriate weight-bearing exercise is one of the most important preventive measures since bone density significantly affects fracture risk. Fall prevention strategies — including home safety modifications, balance training, and review of medications that cause dizziness — are equally important. At MOS we often coordinate with your primary care physician or an endocrinologist to ensure your bone health is optimized long-term.

Meet the specialists

Brian McCormick, MD

Brian McCormick, MD

Adult Reconstruction · Hip and Knee Replacement

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Related conditions

Aseptic Implant LooseningRevision Total Joint Arthroplasty
Medically reviewed by Brian McCormick, MD
Last reviewed June 15, 2026

References

  1. Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000;15(1):59–62. https://doi.org/10.1016/S0883-5403(00)90182-0
  2. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures: classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20(7):857–865. https://doi.org/10.1016/j.arth.2005.02.017
  3. Streubel PN, Gardner MJ, Morshed S, Collinge CA, Gallagher B, Ricci WM. Are patients with locked plating of distal femur fractures at risk for nonunion? J Orthop Trauma. 2010;24(11):692–700. https://doi.org/10.1097/BOT.0b013e3181d ece7a
  4. Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007;89(12):2658–2662. https://doi.org/10.2106/JBJS.G.00024
  5. American Academy of Orthopaedic Surgeons. Fractures Around Hip and Knee Replacements. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/fractures-around-hip-replacements/
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