Periprosthetic fracture Vancouver A: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Periprosthetic fracture Vancouver A Introduction (What it is)

Periprosthetic fracture Vancouver A is a classification label for a specific kind of fracture near a hip replacement.
It refers to fractures around the trochanteric region of the femur (the bony prominences near the top of the thigh bone).
It is most commonly used after total hip arthroplasty (hip replacement) to describe where the break is and what structures may be involved.
Clinicians use it as part of the Vancouver classification system to help communicate findings and plan care.

Why Periprosthetic fracture Vancouver A used (Purpose / benefits)

A periprosthetic fracture is a bone break that occurs “around a prosthesis,” meaning near an implanted joint replacement component. In hip arthroplasty, the femoral stem sits inside the femur, and fractures can occur in different zones around it.

Periprosthetic fracture Vancouver A is used because fracture location matters. A fracture at the trochanters can affect:

The muscle attachments that power hip movement (especially the abductor muscles that help keep the pelvis level while walking).
The mechanical stability of the hip replacement construct (even when the stem itself remains stable).
The risk of persistent limp, weakness, or pain, depending on displacement and healing.

More broadly, the Vancouver system was designed to support consistent decision-making by sorting fractures according to principles that often influence management, such as:

Where the fracture is in relation to the implant
Whether the femoral stem appears stable or loose
The quality of surrounding bone (“bone stock”)

For Vancouver A specifically, the purpose is to clearly identify fractures that are limited to the trochanteric region and may be treated differently than fractures that extend around the stem.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians typically apply Periprosthetic fracture Vancouver A when a patient with a hip replacement has findings consistent with a trochanteric-area fracture, such as:

New hip or upper-thigh pain after a fall or twist in someone with a hip arthroplasty
Sudden onset limp, weakness, or difficulty bearing weight following trauma (severity varies)
Localized tenderness over the greater trochanter (outer hip) or lesser trochanter (inner/posteromedial area)
X-ray or CT evidence of a fracture involving the trochanteric region near the femoral component
Evaluation of persistent lateral hip pain where imaging suggests a trochanteric fracture fragment or nonunion (not all cases are acute)

Contraindications / when it’s NOT ideal

Periprosthetic fracture Vancouver A is a classification category, not a treatment. It may be “not ideal” or not applicable in situations where the injury pattern does not match the definition or where another framework better captures the problem, such as:

Fractures that extend around or below the femoral stem, which may fit other Vancouver categories (for example, patterns centered at the stem or distal to it)
Acetabular (socket-side) periprosthetic fractures, which are not described by Vancouver femoral categories
Fractures around other joints (knee arthroplasty) or plates/screws, where different classification systems are used
Situations where implant stability cannot be assessed from available imaging and clinical context (classification may be uncertain)
Complex fracture patterns involving both the trochanteric region and the femoral shaft, where a broader system (for example, unified approaches) may be preferred
Cases dominated by severe bone loss, infection, or implant failure, where the key clinical issue is not simply trochanteric fracture location

How it works (Mechanism / physiology)

Periprosthetic fracture Vancouver A “works” as a communication and decision-support tool, not as a physiologic treatment. Its usefulness comes from linking anatomy and biomechanics to common clinical priorities.

Biomechanical / clinical principle

The Vancouver system categorizes periprosthetic femur fractures by features that tend to influence management. For Vancouver A, the central principle is:

The fracture is in the trochanteric region, not centered on the stem body.
The femoral stem is often considered stable in many Vancouver A patterns, although stem stability is assessed case by case.
Functional impact may be driven less by stem fixation and more by muscle pull on the fracture fragment and resulting displacement.

Relevant hip anatomy and structures

Key structures around the trochanters include:

Greater trochanter: the outer bony prominence where important hip abductors (gluteus medius and minimus) attach. Injury here can affect abductor function and gait.
Lesser trochanter: a smaller inner prominence where the iliopsoas tendon attaches, contributing to hip flexion.
Proximal femur cortex and cancellous bone: the bone envelope supporting the femoral component and providing healing surfaces.
Femoral stem and fixation interface: cemented or uncemented fixation may change how stability is evaluated. Stability assessment varies by clinician and case.

Onset, duration, and “reversibility”

There is no “onset” like a medication. Instead:

Vancouver A describes an anatomic fracture pattern at a point in time.
The functional effect can change over weeks to months depending on healing (union), displacement, and rehabilitation.
Whether symptoms resolve fully depends on factors such as fracture healing, muscle function, implant stability, and baseline health. Outcomes vary by clinician and case.

Periprosthetic fracture Vancouver A Procedure overview (How it’s applied)

Periprosthetic fracture Vancouver A is not a procedure; it is a classification used during evaluation. A typical high-level workflow looks like this:

Evaluation / exam – History (injury mechanism, timing, prior hip surgery details if available) – Physical exam focused on pain location, gait, and functional changes – Screening for red flags such as neurovascular compromise (assessment varies by setting)
Preparation – Review prior operative notes and implant type when available (cemented vs uncemented, stem design) – Baseline functional status and comorbidities that can affect fracture healing and recovery
Intervention / testing (diagnostic steps) – Imaging, typically starting with X-rays of the hip and femur – Additional imaging (often CT) may be used if fracture lines, displacement, or component stability are unclear (use varies by clinician and case) – Apply the Vancouver classification based on fracture location and other relevant features
Immediate checks – Assess whether the femoral component appears stable or loose (radiographic and clinical judgment) – Evaluate displacement of the trochanteric fragment and potential effect on muscle function
Follow-up – The classification helps guide whether the plan is observation, protected activity, fixation, revision surgery, or a combination – Follow-up typically involves repeat clinical assessments and imaging to monitor healing and implant position (schedule varies by clinician and case)

Types / variations

Periprosthetic fracture Vancouver A is commonly divided into two subtypes based on which trochanter is involved:

Vancouver AG (greater trochanter)
Involves the greater trochanter
Clinically important because the hip abductor muscles attach here
Displacement can be influenced by abductor pull, which may contribute to limp or weakness
Vancouver AL (lesser trochanter)
Involves the lesser trochanter
Important due to iliopsoas attachment
Sometimes considered in the context of whether the fracture is isolated to the lesser trochanter or represents extension of a more complex proximal femur pattern

Common descriptors that further characterize Vancouver A fractures (not always formal subtypes) include:

Displaced vs minimally displaced fragments
Acute fracture vs chronic nonunion (failure of the bone to heal)
Associated osteolysis (bone loss) around the trochanteric region (may be related to wear debris in some arthroplasty contexts; extent varies)
With suspected stem loosening vs without (although loosening is more central to other Vancouver categories, it can still be assessed in Vancouver A presentations)

For context, other Vancouver categories (B and C) describe fractures closer to or below the stem and often emphasize stem stability and bone stock. Clinicians may reference these to ensure the fracture truly fits A rather than another category.

Pros and cons

Pros:

Helps standardize communication between clinicians describing periprosthetic hip fractures
Anchors discussion to anatomy (trochanteric region) that has clear functional implications
Can support initial decision-making by highlighting likely concerns (muscle attachments, displacement)
Encourages systematic evaluation of implant stability and bone quality
Useful for documentation and teaching, especially for trainees and multidisciplinary teams
Facilitates comparison across cases when discussing care pathways (details vary by institution)

Cons:

Classification can be imaging-dependent; subtle fractures or displacement may be missed on initial studies
Interobserver variability can occur, especially in borderline patterns or complex cases
Vancouver A does not fully describe all clinically relevant factors (e.g., soft tissue condition, patient frailty, infection concern)
Trochanteric fractures can coexist with issues not captured by the label, such as abductor tendon tears or prior trochanteric procedures
The label does not dictate treatment; management still varies by clinician and case
May be less intuitive for patients because it is a professional shorthand rather than a diagnosis description

Aftercare & longevity

Because Periprosthetic fracture Vancouver A is a classification, “aftercare” refers to the recovery considerations after a trochanteric-area periprosthetic fracture and whatever management strategy is selected (nonoperative monitoring, fixation, revision, or combined approaches).

Factors that commonly influence recovery and longer-term function include:

Fracture displacement and fragment size: larger or more displaced fragments may affect muscle mechanics more noticeably.
Healing (union) vs persistent gap (nonunion): healing status can influence pain and strength over time.
Hip abductor function (AG fractures): weakness may contribute to limp, fatigue with walking, or balance challenges.
Iliopsoas-related symptoms (AL fractures): some patients report groin discomfort with hip flexion depending on the pattern.
Implant stability: even in trochanteric fractures, clinicians reassess whether the stem remains well fixed.
Rehabilitation approach and activity modification: weight-bearing status, assistive device use, and therapy progression depend on the specific case and chosen intervention.
General health factors that can affect bone healing and recovery capacity, such as nutritional status, smoking status, bone density, and other medical conditions.
Follow-up consistency: repeat assessment and imaging are often used to confirm stability and healing progress; timing varies by clinician and case.

“Longevity” in this context usually means whether the fracture heals and whether the hip replacement remains stable and functional afterward. This can differ substantially across patients and fracture patterns.

Alternatives / comparisons

Periprosthetic fracture Vancouver A is one way of describing a trochanteric periprosthetic femur fracture. Alternatives and comparisons typically fall into two categories: other classification frameworks and different management pathways.

Classification comparisons (how the fracture is described)

Vancouver vs broader unified systems
The Vancouver system is widely recognized for periprosthetic femoral fractures after hip arthroplasty.
Broader systems (often called “unified” approaches) may be used when multiple implants are present or when the pattern does not fit neatly into Vancouver categories. Choice varies by institution and clinician preference.
Descriptive diagnosis only
Some clinicians may document a “greater trochanter periprosthetic fracture” without emphasizing the formal subtype.
This can be understandable for patients, but it may be less standardized for care teams.

Management comparisons (what may be done)

Management is not determined by the label alone, but Vancouver A commonly leads to discussion of:

Observation / monitoring
Often considered when displacement is limited and the implant appears stable, with follow-up imaging and function checks (details vary).
Nonoperative care plus rehabilitation
May focus on pain control strategies, mobility support, and gradual return of strength and function, guided by clinical assessment.
Surgical fixation
May be considered when fragment displacement, functional deficit, or risk of nonunion is a concern. Techniques and implants vary by surgeon and manufacturer.
Revision arthroplasty
Less typical for isolated trochanteric fractures, but may be discussed if there is evidence of implant loosening, major bone loss, or other complicating factors (varies by case).

The key comparison point is that Vancouver A emphasizes trochanteric involvement, whereas many other periprosthetic fracture decisions hinge more strongly on stem stability and bone stock seen in other categories.

Periprosthetic fracture Vancouver A Common questions (FAQ)

Q: What does Periprosthetic fracture Vancouver A mean in plain language?
It means there is a fracture near a hip replacement, specifically involving the bony prominences at the top of the femur (the trochanters). The term is a classification label clinicians use to describe location and likely functional implications. It is not, by itself, a treatment plan.

Q: Does Vancouver A mean my hip implant is loose?
Not necessarily. Many Vancouver A fractures are focused on the trochanteric region and may occur with a stable femoral stem, but stability is assessed individually. Imaging and clinical evaluation are used to judge whether the implant remains well fixed.

Q: Where is the pain usually felt with a Vancouver AG vs AL fracture?
With greater trochanter involvement (AG), pain is often more lateral (outer hip), sometimes worse with walking or lying on that side. With lesser trochanter involvement (AL), discomfort may be felt deeper in the groin or inner hip region, especially with hip flexion. Symptoms vary by clinician and case.

Q: Is this considered serious?
Any fracture around a joint replacement is taken seriously because it can affect function, healing, and implant stability. That said, Vancouver A fractures can range from small, minimally displaced fragments to more disruptive injuries. The overall significance depends on displacement, healing potential, and implant stability.

Q: How is it diagnosed?
Diagnosis typically starts with a history, physical exam, and X-rays of the hip and femur. If the fracture pattern or implant stability is unclear, additional imaging such as CT may be used. The Vancouver label is applied after the fracture location is identified.

Q: What are common treatment options for Vancouver A fractures?
Options may include monitoring with follow-up, rehabilitation-focused care, or surgical fixation, depending on displacement, symptoms, and functional impact. In some cases, evaluation of implant stability influences whether more extensive surgery is considered. Specific choices vary by clinician and case.

Q: How long does recovery take?
Recovery timelines vary widely and depend on fracture healing, displacement, overall health, and whether surgery is performed. Some people improve over weeks, while others require months of follow-up and rehabilitation. Your care team typically monitors progress with repeat assessments.

Q: Will I be allowed to bear weight or walk normally right away?
Weight-bearing recommendations are individualized and depend on the fracture pattern, stability, and treatment approach. Some cases allow earlier walking with support, while others require more protection. This is determined by the treating clinician and can change over time.

Q: When can someone drive or return to work after a Vancouver A fracture?
This depends on pain control, mobility, reaction time, the side involved, and whether assistive devices or restrictions are needed. Job demands also matter (desk work vs physical work). Decisions vary by clinician and case and are usually revisited during follow-up.

Q: What does it typically cost to evaluate and treat?
Costs vary substantially by region, insurance coverage, imaging needs, hospital vs outpatient setting, and whether surgery is required. Even within the same category, resource use can differ based on complexity. A hospital billing team or insurer can usually provide estimates for a specific situation.