Around Hip Replacements
Periprosthetic hip fractures are classified by location:
Dr. Leo Zalikha manages periprosthetic fractures as part of his adult reconstruction practice. His training at Stanford Medicine, combined with his residency exposure to complex trauma at the Detroit Medical Center, gives him the skill set needed for these cases, which sit at the intersection of joint replacement surgery and fracture care.
Why Periprosthetic Fractures Are Different
A fracture in a bone that already contains a prosthetic implant is fundamentally different from a standard fracture:
- The implant complicates fixation: Standard fracture plates and screws may not work around an implant. Specialized techniques, including cables, locking plates, and strut grafts, are often required
- Implant stability matters: If the implant is well-fixed to the bone, it can sometimes be retained while the fracture is stabilized. If the implant is loose, it must be revised at the same time the fracture is repaired
- Bone quality is often poor: Many patients with periprosthetic fractures are older and have osteoporosis, which makes fracture fixation more challenging
- The fracture pattern determines the approach: The location, configuration, and extent of the fracture relative to the implant dictate whether fixation, revision, or a combination is needed
Types of Periprosthetic Fractures
Around the femoral stem:
Fractures near the tip of the stem, around the middle of the stem, or near the implant collar. Treatment depends on whether the stem is still solidly fixed
Around the acetabular component (socket):
Less common but can occur with significant trauma. May require revision of the cup
Between the stem tip and the knee:
A fracture in the mid-femur that involves the area below the hip implant
Around Knee Replacements
Periprosthetic knee fractures most commonly involve:
The distal femur (above the knee implant):
The most common type. The bone above the femoral component of the knee replacement fractures, often after a fall
The proximal tibia (below the tibial component):
Less common but can be complex
The patella:
Fracture of the kneecap around or beneath a patellar implant
Between Hip and Knee Implants (Interprosthetic Fractures)
Patients who have both a hip replacement and a knee replacement in the same leg can sustain a fracture in the femur between the two implants. These are particularly challenging because the fracture must be stabilized without compromising either prosthesis.
How These Fractures Are Treated
When the Implant Is Stable
If the existing implant remains well-fixed to the bone, the fracture can often be treated with internal fixation (plates, screws, cables) while retaining the original prosthesis. This is a less invasive approach, but it requires adequate bone quality and a fracture pattern amenable to fixation.
When the Implant Is Loose
If the fracture has destabilized the implant, or if the implant was already loose before the fracture, revision surgery is performed. The loose implant is removed, the fracture is stabilized, and a new, typically longer-stemmed implant is placed that bypasses the fracture site and achieves fixation in healthy bone. Learn more about revision hip replacement.
When Both Fixation and Revision Are Needed
Some fractures require a combination of revision arthroplasty and supplemental fixation (cables, cerclage wires, bone graft, or strut allografts) to achieve a stable construct.
What Patients Should Know
- Timing matters: Periprosthetic fractures are typically treated surgically within days of the injury. Delays can lead to additional bone displacement, increased surgical complexity, and worse outcomes. If you sustain a fracture around a joint replacement, prompt evaluation by a surgeon experienced in these cases is important.
- Recovery is longer: Periprosthetic fracture surgery generally requires a longer recovery than primary joint replacement. Protected weight-bearing for several weeks is common while the fracture heals. The specific recovery protocol depends on the fracture pattern and the stability of the repair.
- Bone health matters: Many periprosthetic fractures occur in patients with osteoporosis. Optimization of bone health (including vitamin D supplementation, calcium, and potentially medication for osteoporosis) is an important part of the long-term treatment plan.
- Not every surgeon handles these cases: Periprosthetic fractures require a surgeon who is comfortable with both arthroplasty and fracture fixation techniques. Dr. Zalikha's training in complex trauma during residency and revision arthroplasty during fellowship provides the combined skill set these cases demand.
When to Contact Dr. Zalikha
If you have a hip or knee replacement and sustain a fall or injury resulting in sudden pain, inability to bear weight, or deformity around the joint, go to the nearest emergency department. Once the fracture is identified, your treatment team should involve a surgeon with experience in periprosthetic fracture care.
For patients already diagnosed with a periprosthetic fracture who want a fellowship-trained opinion on their treatment plan, Dr. Zalikha offers in-person consultations and virtual second opinions.
Get Expert Evaluation for a Periprosthetic Fracture
For evaluation of a periprosthetic fracture, contact Dr. Zalikha’s office at (562) 362-5024. For patients outside the area, a virtual second opinion is available.