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Periprosthetic Hip Fracture

Comprehensive patient guide to fractures around hip replacements - Vancouver classification, surgery options, recovery timeline, and preventing fractures after hip replacement

📅Last reviewed: January 2026đŸĨBones & Joints

📖What is Periprosthetic Hip Fracture?

Comprehensive patient guide to fractures around hip replacements - Vancouver classification, surgery options, recovery timeline, and preventing fractures after hip replacement

đŸ”ŦWhat Causes It?

  • Low-energy fall from standing height
  • High-energy trauma
  • Stress fracture through loose prosthesis
  • Intraoperative fracture

⚠ī¸Risk Factors

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You may be at higher risk if:

  • Age over 75 (bone weakens, fall risk increases, osteoporosis worsens)
  • Female sex (2-3 times higher risk than males - osteoporosis, smaller bones)
  • Osteoporosis (weak bone around prosthesis fractures more easily)
  • Time since hip replacement (risk 0.1% at surgery, 1-2% at 5 years, 4-5% at 10-15 years)
  • Loose hip prosthesis (Vancouver B2/B3 - loosening causes stress concentration and bone loss)
  • Osteolysis (wear debris causes bone loss around prosthesis - visible on X-ray as dark areas)
  • Previous revision hip surgery (bone loss from removing old prosthesis, weaker bone stock)
  • Rheumatoid arthritis (osteoporosis from disease and medications, bone loss)
  • Long-term corticosteroid use (prednisone causes osteoporosis)
  • Neurological conditions affecting balance (Parkinson's disease, stroke - increases fall risk)
  • Cemented femoral stems (some studies show higher fracture risk vs uncemented)
  • Uncemented stems with press-fit (stress concentration at stem tip - Vancouver C fractures)
  • Severe osteopenia on DEXA scan (T-score below -2.5)

🛡ī¸Prevention

  • ✓Osteoporosis treatment (bisphosphonates reduce fracture risk 40-50%) - ALL patients with hip replacements over 65 should have DEXA scan and osteoporosis treatment if T-score below -2.0
  • ✓Falls prevention critical: Balance training (physiotherapy, tai chi reduces fall risk 30-40%), Home safety (remove trip hazards - loose rugs, cords, clutter; install grab rails in bathroom; improve lighting), Vision optimization (glasses, cataract surgery), Medication review (reduce sedatives, blood pressure medications causing dizziness), Walking aids (walker, stick) if unsteady, Hip protectors (padded underwear - may reduce fracture risk if fall occurs)
  • ✓Regular X-ray surveillance (every 2-5 years after hip replacement to detect early loosening or osteolysis)
  • ✓Prompt assessment of new hip pain (groin/thigh pain may indicate loosening - planned revision safer than waiting for fracture)
  • ✓Maintain muscle strength (quadriceps, hip abductors protect against falls)
  • ✓Avoid high-risk activities (climbing ladders, step stools - use grabber tools instead)
  • ✓Vitamin D supplementation (800-1000 IU daily reduces fall risk by improving muscle strength)
  • ✓Address urinary urgency (rushing to toilet common cause of falls - slow down, use bedside commode at night)