JBJS - 2026-09-22 - Journal Article
Prevention of Periprosthetic Fractures: What Should We Be Doing to Address This Impending Epidemic?
Lamb JN, Whitehouse M
Topics
Key Takeaway
Periprosthetic femoral fractures after THA carry mortality rivaling native hip fragility fractures, with reoperation rates and implant survival after fixation substantially compromised, demanding prevention as a core component of arthroplasty care.
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Summary
This narrative review examines mechanisms, classification, and prevention strategies for periprosthetic proximal femoral fractures following THA in the context of rising arthroplasty volumes and an aging implant-bearing population. The authors synthesize national joint registry projections and existing literature to argue that absolute fracture numbers will rise substantially over coming decades. Key conclusions are that mortality after periprosthetic fractures rivals hip fragility fracture mortality, reoperation rates are high, and implant survival after fixation is significantly compromised.
Key Limitation
As a narrative expert opinion review without systematic search methodology or quantitative synthesis, the strength of specific prevention recommendations cannot be graded and may reflect author bias.
Original Abstract
➢ Periprosthetic fractures after total hip arthroplasties represent a growing surgical emergency with high associated morbidity and mortality.➢ Projections from national joint registries indicate that the absolute number of these fractures will rise substantially over the coming decades as the volume of primary arthroplasties increases and the population with implants ages.➢ The consequences for patients and health systems are severe: mortality following periprosthetic fractures rivals that following hip fragility fractures, reoperation rates are high, and implant survival after fixation is substantially compromised. Therefore, prevention must be considered an integral part of arthroplasty care.➢ We examine the mechanisms and classification of periprosthetic fractures with a focus on periprosthetic proximal femoral fractures after a total hip arthroplasty.➢ Arthroplasty surgeons must adopt a holistic, multidisciplinary approach to reduce harm to patients.