This 2004 symposium article by Masri, Meek, and Duncan reviews the epidemiology, risk factors, classification, and treatment principles for periprosthetic fractures after total hip arthroplasty — both acetabular and femoral, intraoperative and postoperative — using the Vancouver classification as the organizing framework for treatment decision-making.
When you encounter a periprosthetic femoral fracture after THA, classify it by Vancouver type first — implant stability is the pivotal question that separates ORIF (B1, stable stem) from mandatory revision with long-stem bypass (B2, loose stem, good bone) or structural allograft/proximal femoral replacement (B3, loose stem, poor bone).
If you're heading into cementless revision THA, anticipate a 1-in-5 chance of intraoperative fracture and have cerclage wires and cortical strut allografts on the table.
This 2004 symposium article by Masri, Meek, and Duncan reviews the epidemiology, risk factors, classification, and treatment principles for periprosthetic fractures after total hip arthroplasty — both acetabular and femoral, intraoperative and postoperative — using the Vancouver classification as the organizing framework for treatment decision-making.
When you encounter a periprosthetic femoral fracture after THA, classify it by Vancouver type first — implant stability is the pivotal question that separates ORIF (B1, stable stem) from mandatory revision with long-stem bypass (B2, loose stem, good bone) or structural allograft/proximal femoral replacement (B3, loose stem, poor bone).
If you're heading into cementless revision THA, anticipate a 1-in-5 chance of intraoperative fracture and have cerclage wires and cortical strut allografts on the table.