# Periprosthetic fractures: a break around a hip or knee implant

When someone with a joint replacement falls, the bone can break around the implant. These are among the most demanding fractures in orthopaedics, and the right treatment starts with one question: is the implant still stable?

## What a periprosthetic fracture is

It is a fracture in the bone around an artificial joint. The implant is stiffer than the bone that surrounds it, and in a fall the forces concentrate where the metal ends. That is where the bone breaks.

## Why they are becoming more common

- More and more people live with a hip or knee implant, and for more years.
- Falls become more frequent with age.
- [Osteoporosis](https://www.manoskotidis.com/en/osteoporosis/) weakens the bone around the implant.
- An implant that has loosened over the years leaves the bone more vulnerable.

## Where they happen

- **Around a hip implant.** Most often in the thigh bone, around or below the stem. Less often in the socket.
- **Around a knee implant.** Most often at the lower end of the thigh bone, just above the implant. Less often in the shin bone or the kneecap.

## How to recognise one

Sudden pain in the thigh or knee after a fall, not being able to put weight on the leg and, often, deformity or swelling. In someone with a joint replacement, any fall followed by pain that does not settle needs an X-ray the same day.

## The question that decides the treatment

Two things decide what happens next: where the fracture is, and whether the implant is still well fixed to the bone.

X-rays show the fracture. A CT scan helps to show whether the implant has loosened and how much bone is left to hold it. Your earlier X-rays are valuable too, and so is the history: thigh pain that was there before the fall may mean the implant had already loosened.

## Treatment

- **Stable implant.** The fracture is fixed with special plates, screws and cables around the bone. The implant stays in place.
- **Loose implant.** Fixation alone is not enough. A revision is needed, meaning the implant is replaced with a longer one that bypasses the fracture and rests in healthy bone.
- **Treatment without surgery.** It has a place only in a few stable fractures that have not shifted, or when general health does not allow an operation.

These operations call for experience in both trauma and joint replacement, and for careful planning before surgery.

## Research work

In 2024, at the EFORT Congress in Hamburg, Dr Skotidis presented a retrospective study on periprosthetic femoral fractures after total hip replacement, comparing fixation with revision of the implant. See his [profile](https://www.manoskotidis.com/en/about/).

## Recovery

The aim is to get the patient out of bed as early as possible. How much weight the leg can take depends on the stability achieved at surgery and on bone quality, and is set by the surgeon. Healing usually takes three to six months and is followed with X-rays. Physiotherapy gradually brings back walking and strength.

## How to lower the risk

- Testing for and treating osteoporosis.
- Balance exercises and a safe home, for fewer falls.
- Regular check-ups of the joint replacement with an X-ray, even when nothing hurts. That is how loosening is caught early.
- An examination if new pain appears in the thigh or knee without a fall.

Read about [hip replacement](https://www.manoskotidis.com/en/hip-replacement-asi/), [knee replacement](https://www.manoskotidis.com/en/total-knee-replacement/) and [upper and lower limb fractures](https://www.manoskotidis.com/en/fractures/) too.

## Common questions

### I have a joint replacement and I fell. Should I worry?

If you walk without pain, usually not. If your thigh or knee hurts or you struggle to put weight on the leg, you need an X-ray the same day.

### Are periprosthetic fractures always operated on?

Almost always. Treatment without surgery has a place only in a few stable fractures that have not shifted.

### Will my implant have to be changed?

Only if it has loosened. When it is stable it stays in place and the fracture is fixed around it.

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Manos Skotidis, MD, MSc · Orthopaedic Surgeon · Hip & Knee
Phone: +30 694 248 7303 · Email: em.skotidis@gmail.com
Appointments: https://www.manoskotidis.com/en/#book