Hip Fractures After Hip Replacement

Hip fractures following a hip replacement are called periprosthetic hip fractures – fractures that occur around arthroplasty hardware and can either involve the femur or the acetabulum (less common).¹,²

To understand periprosthetic hip fractures, we need to know the anatomy of a hip replacement. In hip arthroplasty, the femoral head (ball) is replaced with a metal ball, the acetabulum (socket) is replaced with a metal socket, and in place of cartilage is a plastic spacer to allow for smooth movement of the prosthetic ball-and-socket joint.

Causes

A traumatic injury often causes periprosthetic hip fractures. More fragile bones, such as those in patients of advanced age or from certain chronic illnesses like osteoporosis, are more likely to fracture due to a fall. Fractures during arthroplasty (total hip replacement) are rare, happening in 0.1-4% of cases.1 Occasionally, the stem hardware loosens due to activity, thinning bone, or an infection.

Symptoms

If you have a hip replacement and are experiencing severe pain in your hip—especially following a traumatic injury such as a fall—it is important to visit a qualified orthopedic specialist. A proper diagnosis can prevent further injury and allow for the best outcome. The most common symptoms of a periprosthetic hip fracture include:

Pain usually in the groin and upper thigh,
Swelling or bruising of the hip or thigh,
Inability to bear weight,
Lower leg deformity.

Diagnosing

Most patients will be unable to bear weight following a periprosthetic hip fracture and will end up in the emergency room via ambulance. The diagnostic process begins with a physical examination and medical history. X-rays are often the primary diagnostic imaging test for a periprosthetic hip fracture. A CT scan may be ordered to provide a more detailed image of the fracture, allowing your orthopedic surgeon to plan your treatment.

Treatments

Most periprosthetic hip fractures require surgical fixation and/or revision of the hip joint.

Surgical Treatment

Revision arthroplasty in which some or all the hardware is replaced.
Open reduction and internal fixation (ORIF).
When the arthroplasty hardware is intact, a plate and screws or cables may be used to repair the fracture keeping the hip replacement in place.
A combination of arthroplasty and ORIF.

Complications

All surgical procedures come with the risk of pain, bleeding, nerve damage, and wound problems. Your orthopedic surgeon will discuss risks and possible complications before surgery. Following revision arthroplasty or ORIF, complications include hip dislocation, hardware loosening, leg length discrepancy, repeat fractures, and poor bone growth/healing.

Hip fractures also have a risk of medical complications, including delirium, pulmonary embolism (blood clot in the lung), deep venous thrombosis (blood clot in the leg), pneumonia, myocardial infarction (heart attack), heart failure, urinary infection, acute kidney injury, anemia, and skin pressure ulcers.

References:

Pavelka T, Salášek M, Weisová D. Periprosthetic Femoral Fractures after Total Hip Replacement. Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca. 2017;84(1):52-58. Accessed October 24, 2023. https://pubmed.ncbi.nlm.nih.gov/28253947/
Sheth, MD NP, Foran, MD JRH. Fracture After Total Hip Replacement. Ortho Info. Published April 2023. https://orthoinfo.aaos.org/en/diseases–conditions/fracture-after-total-hip-replacement/