Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 27:67:238-242.
doi: 10.1016/j.jor.2025.05.052. eCollection 2025 Sep.

Revision for initial periprosthetic femur fracture increases likelihood of subsequent fracture in total hip arthroplasty

Alan D Lam  1 , Nihir Parikh  1 , Adam S Kohring  2 , R Craig Juniewicz  3 , Elizabeth Abe  1 , Samuel P Alfonsi 3rd  1   4 , Ryan M Sutton  1 , Chad A Krueger  1
Affiliations

Revision for initial periprosthetic femur fracture increases likelihood of subsequent fracture in total hip arthroplasty

Alan D Lam et al. J Orthop. .

Abstract

Background: Although a rare complication, periprosthetic fractures (PPF) following total hip arthroplasty (THA) are becoming more common. Revision THA (rTHA) for PPF is associated with high failure rates, and there is a paucity of literature reporting how often there is a subsequent PPF in these patients. This study aimed to determine the rate of femoral re-fracture following rTHA in patients with an initial PPF after primary THA.

Methods: The retrospective study identified 2044 patients who underwent rTHA between 2017 and 2023. Propensity score-matched cohort analysis was conducted to control for demographic variables. The primary outcome was the re-fracture rate and survivability of those patients who were revised for PPF.

Results: There were 183 patients who sustained an initial PPF and underwent subsequent rTHA. Of these patients, five (2.7 %) sustained re-fracture of the femur. After matching, there was a 3.7 % re-fracture rate in patients revised for an initial PPF compared to those who were not revised for PPF (0.37 %, P = 0.017). The 1-year re-fracture-free survivability of patients revised for initial PPF was 95.9 %, which was significantly lower compared to patients revised for non-PPF indications (99.6 %; P = 0.008). Older patients, women, elevated Charlson Comorbidity Index (CCI), and posterior approach during rTHA were found to be risk factors for PPF (P < 0.001).

Conclusion: Patients who were revised for an initial PPF had nearly a 10 times increased risk of re-fracturing compared to patients revised for other indications in THA. However, the similar readmission and failure rates and 1-year implant survivorship suggest comparable outcomes. Further analysis with a larger cohort and more outcome events is necessary.

Keywords: Complications; Periprosthetic femur fracture; Periprosthetic fracture; Re-fracture; Revision total hip arthroplasty.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Lindahl H., Garellick G., Regnér H., Herberts P., Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88(6):1215–1222. doi: 10.2106/JBJS.E.00457. - DOI - PubMed
    1. Marsland D., Mears S.C. A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil. 2012;3(3):107–120. doi: 10.1177/2151458512462870. - DOI - PMC - PubMed
    1. Abdel M.P., Houdek M.T., Watts C.D., Lewallen D.G., Berry D.J. Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Jt J. 2016;98-B(4):468–474. doi: 10.1302/0301-620X.98B4.37203. - DOI - PubMed
    1. Abdel M.P., Watts C.D., Houdek M.T., Lewallen D.G., Berry D.J. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Jt J. 2016;98-B(4):461–467. doi: 10.1302/0301-620X.98B4.37201. - DOI - PubMed
    1. Lindahl H., Malchau H., Herberts P., Garellick G. Periprosthetic femoral fractures. J Arthroplast. 2005;20(7):857–865. doi: 10.1016/j.arth.2005.02.001. - DOI - PubMed

LinkOut - more resources