Injury - 2026-06-22 - Journal Article
Periprosthetic fracture following hip resurfacing arthroplasty: treatment guidance using the 'SAVE' classification system.
Al-Jabri T, Mirdad RS, Wong JM, Shankar S, Masterson S, Giannoudis PV
Topics
Key Takeaway
The SAVE classification (Stability, Anatomical location, Viability, Environment) is proposed as a treatment-oriented framework for periprosthetic fractures after hip resurfacing arthroplasty, a failure mode not adequately addressed by existing systems such as the Vancouver classification.
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Summary
This expert-opinion article addresses the gap in classification and management guidance for periprosthetic fractures following hip resurfacing arthroplasty, which differ mechanistically from fractures around stemmed THA. The authors propose the SAVE classification incorporating four domains—implant Stability, Anatomical fracture location, Viability of the femoral head-neck segment, and local Environment (including adverse local tissue reaction and metal ion burden)—to guide the preserve-versus-revise decision. No outcome data are reported; the framework is consensus- and expert-derived.
Key Limitation
The SAVE classification is entirely expert-derived with no clinical validation, inter-observer reliability data, or outcome comparison against current ad hoc decision-making.
Original Abstract
Periprosthetic fracture following hip resurfacing arthroplasty is an uncommon but important complication and represents a distinct failure mode compared with fractures around conventional stemmed total hip arthroplasty. Existing periprosthetic fracture classifications are useful descriptively, but they do not fully address the biomechanical and biological considerations unique to hip resurfacing. Herein, the epidemiology, risk factors, mechanisms of failure, diagnostic workup, classification, and management of periprosthetic fractures following hip resurfacing arthroplasty is presented. Particular emphasis is placed on early femoral neck failure, avascular necrosis, femoral neck notching, varus component positioning, implant stability, adverse local tissue reaction, metal ion assessment, and the role of cross-sectional imaging. The article also proposes the SAVE classification, a treatment-oriented framework incorporating four key domains: Stability of the implant, Anatomical fracture location, Viability of the femoral head-neck segment, and local Environment. The SAVE classification provides a practical framework for determining whether the resurfacing construct can realistically be preserved or whether revision arthroplasty is more appropriate. By linking classification directly to treatment strategy, it may improve consistency in assessment and guide decision-making in these complex injuries.