Fracture After Total Hip Replacement A periprosthetic hip fracture is a broken bone that occurs around the implants of a total hip replacement. It is a serious complication that most often requires surgery. Although a fracture may occur during a hip replacement procedure, the majority of periprosthetic fractures occur after a patient has spent years functioning well with a hip replacement. Fortunately, these fractures are rare. The treatment of these fractures is often challenging because patients are older and may have thinning bone or other medical conditions. Description Most periprosthetic fractures occur around the stem of the metal component placed in the femur. Fractures of the hip socket (acetabulum) are less common. How severe the fracture is depends upon two main factors: The quality and strength of the bone around the implant The amount of force involved in the injury Cause Periprosthetic femur fractures are most often the result of a fall. These fractures can also be caused by a higher energy force, such as a direct blow to the side of the hip or motor vehicle collision. Several things can put people at higher risk for a periprosthetic hip fracture, such as: Having more risk factors for a fall, such as muscle weakness, poor vision, or poor balance Having a condition that weakens bone, such as osteoporosis A loosened femoral stem is also a major risk factor. This loosening typically occurs over a long period of time, and is most often due to everyday activity. It can also result from a thinning of the bone called osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: Pain around the hip or thigh Swelling and bruising around the hip or thigh Inability to bear weight on the injured leg Injured leg appears shorter or deformed Examination Because these types of injuries are often very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency room. In the emergency room, both an emergency room physician and an orthopaedic surgeon will be involved in your care. They will closely examine the affected hip. The lower portion of the leg will be assessed for good blood flow, as well as to ensure that the main nerve that travels around the hip joint (the sciatic nerve) is functioning well. Tests Imaging tests. X-rays of your pelvis, hip, and femur bones will show your doctor how complex the fracture is. These images can show the quality of the bone, how many pieces of broken bone there are, as well as the extent of displacement (gaps between broken pieces). In some cases, a computed tomography (CT) scan will also be obtained. These scans provide three-dimensional images of bony structures. Laboratory tests. You will likely be admitted to the hospital. Blood and other laboratory tests can provide your doctor with important information about your general health and help prepare you for surgery. Injury Stabilization You will not be permitted to put any weight on the injured leg. Your doctor may place a small traction device on your foot to help keep your leg straight and prevent any further damage. Treatment Most cases of periprosthetic hip fractures require surgery. To determine the right treatment for you, your doctor will consider several factors, including: The type and location of the fracture The quality of the remaining bone Whether the implant in the femur is loose Your overall medical health Patients that require surgery may be in the hospital for several days before the surgery is performed. This is often because patients with periprosthetic fractures need to be medically stabilized. This "clearing" by a team of doctors reduces the inherent risks of the surgery. The general approaches to treating periprosthetic hip fractures include: Open reduction and internal fixation Revision of the total joint implants A combination of both Open Reduction and Internal Fixation If your implant is still firmly fixed into your femur bone, your doctor may recommend internal fixation to treat the fracture. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment, and then held together with special screws, cables, or by attaching metal plates to the outer surface of the bone. In some cases, a bone graft is also used to help the broken bone heal. Bone grafting involves transplanting bone tissue to support areas of weakened bone. Allograft bone (bone from a deceased donor that has been sterilized and stored) is most often used in treatment for periprosthetic hip fractures. Joint Revision In some cases of periprosthetic hip fracture, the implant stem is loose. In these situations, the original implant must be removed from the bone and replaced with a new implant. This procedure is called a joint revision. Revision surgery may require special components. Typically, the new implant will have a longer stem. In some cases, allograft bone may be used to supplement weak or missing bone. Possible Complications of Surgery Complications following surgery for periprosthetic fractures can be serious. The most common complications include: Infection Blood clots Dislocation Limb length inequality Poor fracture healing Repeat fracture Lack of in-growth of the new stem placed in the femur bone Nerve or blood vessel injury Additional Surgery In some cases, a repeat operation is necessary to address the complication. It is important to talk with your orthopaedic surgeon about the risks and benefits of the procedure before undergoing surgery.