Periprosthetic fracture: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Periprosthetic fracture Introduction (What it is)

Periprosthetic fracture means a bone fracture that happens around an orthopedic implant.
It is most commonly discussed after joint replacement surgery, such as a hip or knee replacement.
It can occur during surgery or at any time afterward.
Clinicians use the term to guide evaluation and treatment planning.

Why Periprosthetic fracture used (Purpose / benefits)

Periprosthetic fracture is not a device or a treatment by itself—it is a clinical diagnosis that describes where a fracture occurred in relation to an implant. Using this specific term helps clinicians communicate clearly, because fractures around implants behave differently than fractures in normal (non-implanted) bone.

Key reasons the term and diagnosis matter:

It frames the problem accurately. A fracture near a hip or knee implant can affect both the bone and the implant’s fixation (how well it is anchored).
It supports structured decision-making. Management often depends on whether the implant is stable, where the fracture is located, and the quality of the surrounding bone.
It guides imaging and testing choices. Clinicians may look for implant loosening, bone loss, or signs of other complications that can change treatment.
It improves care coordination. Orthopedic surgeons, emergency clinicians, radiologists, physical therapists, and primary care teams can align on a shared classification and plan.
It sets expectations for recovery. Healing time, weight-bearing limits, and rehabilitation needs may differ from a typical fracture because an implant is involved.

In short, identifying a Periprosthetic fracture helps clinicians choose an approach that addresses both fracture healing and implant function.

Indications (When orthopedic clinicians use it)

Clinicians consider or use the diagnosis of Periprosthetic fracture in scenarios such as:

New pain, swelling, bruising, deformity, or inability to bear weight in a limb with a joint implant
A fall or twist injury in someone with a prior hip, knee, or shoulder arthroplasty
Sudden change in function (for example, new limp, leg weakness, or inability to use the joint normally) after an implant procedure
Concern for implant loosening or failure with a suspected associated fracture
Injury occurring during joint replacement surgery (intraoperative fracture)
Fracture identified incidentally on imaging obtained for another reason (less common, but possible)
Fracture around other implanted hardware (for example, plates, screws, or intramedullary nails), depending on how a clinician defines “periprosthetic” in their practice

Contraindications / when it’s NOT ideal

Because Periprosthetic fracture is a diagnosis rather than a single intervention, “contraindications” usually apply to a specific treatment strategy rather than to the term itself. Situations where this diagnosis may not be the best fit—or where a different approach may be more appropriate—include:

Fractures clearly remote from any implant, where standard fracture classification and treatment pathways apply
Pain after joint replacement without a fracture, where causes such as tendon irritation, bursitis, instability, implant loosening without fracture, or infection may be considered instead
Stress reactions or bone remodeling changes around an implant that do not meet criteria for a true fracture (interpretation varies by clinician and imaging findings)
Non-operative management may be less suitable when the implant appears unstable, alignment is poor, or the fracture pattern is unlikely to remain stable (varies by clinician and case)
Certain fixation methods may be less suitable when bone quality is poor, fracture pattern is complex, or implant design limits available fixation options (varies by material and manufacturer)

How it works (Mechanism / physiology)

A Periprosthetic fracture occurs when bone around an implant fails under force or repetitive stress. The underlying biomechanical issue is that the bone-implant system behaves differently than native bone alone.

Core biomechanical and physiologic principles

Stress distribution changes: Implants can shift how load travels through the bone. Some regions may experience higher stress, while others experience “stress shielding” (less load), which can influence bone strength over time.
Bone quality matters: Osteoporosis, aging-related bone changes, and other health conditions can reduce bone strength, increasing fracture risk.
Implant stability is central: A key clinical question is whether the implant is still well-fixed. A stable implant may allow fracture fixation without replacing the implant, while an unstable implant may require revision (replacement or re-seating of components).
Healing follows general fracture biology: The body repairs fractures through inflammation, new bone formation, and remodeling. However, the presence of metal (or other implant materials) can complicate mechanical stability and fixation options.

Relevant hip anatomy and structures (common example)

Periprosthetic fractures are frequently discussed in the context of hip arthroplasty. Important structures include:

Femur: Especially the upper femur around the femoral stem (the implant part inside the thigh bone).
Acetabulum (hip socket): Fractures can occur around the cup component as well.
Cortex and cancellous bone: The dense outer shell and the inner spongy bone both influence fixation and healing.
Soft tissues: Muscles and tendons around the hip contribute to stability and can be affected by injury and surgery.

Onset, duration, and reversibility

Onset: Can be sudden (after a fall) or occasionally more gradual (with stress-related injury patterns).
Duration: Healing time varies widely depending on fracture type, stability, and patient factors; it is not predictable from the term alone.
Reversibility: The fracture itself can heal, but some cases may lead to lasting changes in function or require implant revision. Outcomes vary by clinician and case.

Periprosthetic fracture Procedure overview (How it’s applied)

Periprosthetic fracture is not a single procedure. It is a diagnosis that triggers an evaluation and management pathway. A typical high-level workflow may include:

Evaluation / exam – History of the injury (fall, twist, sudden pain, or postoperative event) – Review of implant history (type of joint replaced, timing, prior complications) – Physical exam focusing on pain location, limb alignment, swelling, and neurovascular status
Preparation – Stabilization of the limb for comfort and safety as needed – Review of medications and health conditions that may affect bleeding risk, bone health, or healing (varies by clinician and setting)
Intervention / testing – Imaging: X-rays are commonly used first. CT may be used to better define fracture pattern or evaluate component position and bone stock, depending on the case. – Assessment of implant stability: Determined from imaging and clinical context; sometimes definitively confirmed during surgery.
Immediate checks – Confirm alignment and safety of the limb – Monitor for complications related to injury (for example, skin compromise or neurovascular concerns), depending on fracture location and severity
Follow-up – A treatment plan may involve observation, bracing/immobilization, surgery for fixation, implant revision, or a combination. – Rehabilitation and repeat imaging schedules vary by clinician and case.

Types / variations

Periprosthetic fractures are commonly described by location, timing, implant stability, and bone quality. Clinicians may use formal classification systems, especially around hip replacements, to standardize decisions.

Common variations include:

By timing
Intraoperative: Occurs during the joint replacement procedure.
Postoperative: Occurs after surgery, from soon after implantation to many years later.
By location (hip examples)
Around the femoral stem: Fractures of the femur near or below the implant stem.
Around the acetabular component: Fractures involving the socket region.
Trochanteric region: Near muscle attachment points at the top of the femur.
By implant stability
Stable implant: The component remains well-fixed to bone.
Loose/unstable implant: The component may have lost fixation, changing treatment priorities.
By bone stock (bone quantity/quality)
Adequate bone for fixation
Reduced bone stock (bone loss), which can limit fixation choices and influence whether revision is needed
By implant and material factors
Stem shape, length, and fixation method (cemented vs uncemented) can affect fracture patterns and surgical options.
These considerations vary by material and manufacturer.

Pros and cons

Periprosthetic fracture as a diagnosis has practical strengths and limitations in real-world care.

Pros:

Clarifies that the fracture involves an implant-bearing bone, which changes management considerations
Prompts evaluation of both the fracture and implant stability
Supports structured communication between clinicians and across care settings
Encourages careful imaging review and appropriate classification
Helps anticipate rehabilitation complexity compared with standard fractures
Aligns treatment planning with goals of restoring function and protecting implant fixation

Cons:

Can be confusing for patients because it describes location rather than a single treatment
Treatment pathways are variable and depend heavily on fracture type and implant stability
Surgical planning may be more complex than for typical fractures
Recovery and weight-bearing timelines can be less predictable than for non-implant fractures
Some cases require revision arthroplasty, which may be more involved than fixation alone
Terminology and classification use can differ across institutions and clinicians

Aftercare & longevity

Aftercare depends on the fracture pattern, implant stability, treatment chosen (non-operative vs surgical), and individual health factors. In general, outcomes and “longevity” relate to both fracture healing and ongoing implant performance.

Factors that commonly influence recovery and durability include:

Fracture characteristics
Location, displacement (how far the bone moved), and complexity
Whether the fracture compromises the implant’s fixation
Treatment approach
Non-operative plans may require activity modification and close monitoring, depending on stability
Surgical options may include fixation (plates/cables/screws), revision of implant components, or both, depending on the case
Rehabilitation and follow-up
Physical therapy may focus on safe mobility, strength, balance, and gradual return of function
Follow-up imaging may be used to monitor healing and hardware position (frequency varies by clinician and case)
Weight-bearing status
Some patients may have restrictions for a period of time, while others may progress sooner; this is highly individualized and fracture-dependent
Bone and overall health
Bone density, nutrition, smoking status, and medical conditions can influence healing potential
Fall risk, balance, and vision issues can affect re-injury risk
Implant variables
Implant design, fixation method (cemented vs uncemented), and prior wear or loosening can affect both the initial injury and long-term results (varies by material and manufacturer)

Alternatives / comparisons

Because Periprosthetic fracture is a diagnosis, “alternatives” usually mean (1) other diagnoses that can look similar, and (2) different management pathways.

Diagnostic comparisons (what else it could be)

A typical (non-periprosthetic) fracture: Similar symptoms, but not involving an implant-bearing region.
Implant loosening without fracture: May cause pain and functional decline; imaging interpretation can be nuanced.
Dislocation or instability of a joint replacement: Can cause sudden pain and inability to move the joint normally.
Infection around an implant: Can cause pain and systemic symptoms in some cases; evaluation varies by clinician and setting.
Soft-tissue causes of pain: Bursitis, tendon irritation, muscle strains, or referred pain from the spine may mimic joint pain.

Management comparisons (high-level)

Observation/monitoring vs surgery
Monitoring may be considered for stable, minimally displaced fractures with a stable implant in selected cases.
Surgery may be considered when alignment, stability, or implant fixation is a concern.
Fixation (repair) vs revision (replace implant parts)
Fixation aims to stabilize the fracture while preserving the existing implant if it is stable.
Revision addresses cases where the implant is loose/unstable or where bone stock and mechanics favor replacement strategies.
Imaging choices
X-ray is often the starting point.
CT may add detail about fracture lines and component position when plain films are unclear or surgical planning needs more information (use varies by clinician and case).

Periprosthetic fracture Common questions (FAQ)

Q: Is a Periprosthetic fracture the same as a “fracture after hip replacement”?
It is a broad category that includes fractures occurring around an implant, including after hip replacement. It can involve the femur, the socket area, or other implant-adjacent regions. It may happen soon after surgery or years later.

Q: Does a Periprosthetic fracture always require surgery?
Not always. Some fractures may be managed without surgery when the implant is stable and the fracture pattern is considered stable. Many cases do require surgical treatment, but the decision varies by clinician and case.

Q: How is a Periprosthetic fracture diagnosed?
Diagnosis typically combines a clinical evaluation with imaging, most often X-rays. Additional imaging such as CT may be used when details of the fracture or implant position are not clear. Clinicians also assess whether the implant appears stable.

Q: What does “implant stability” mean, and why does it matter?
Implant stability refers to whether the joint replacement components remain well-fixed to the bone. If an implant is loose, fixing the fracture alone may not restore function or alignment. Stability strongly influences whether fixation, revision, or a combined approach is considered.

Q: How painful is a Periprosthetic fracture?
Pain levels vary widely with fracture location, displacement, and individual factors. Some people have sudden severe pain and inability to bear weight, while others may notice escalating pain after a lesser injury. Pain experience and function limitations vary by clinician and case.

Q: How long does recovery take?
Recovery timelines depend on the fracture type, treatment approach, and overall health. Healing and rehabilitation may take weeks to months, and complex cases can take longer. Your expected timeline is typically discussed after imaging review and treatment planning.

Q: Will I be able to walk or bear weight during recovery?
Weight-bearing plans are individualized. Some fractures and repairs allow earlier weight-bearing, while others require restrictions to protect healing and implant fixation. The plan varies by clinician and case.

Q: When can someone return to work or drive after a Periprosthetic fracture?
Return to work and driving depend on pain control, mobility, weight-bearing status, and (when applicable) surgical recovery. Safety considerations include reaction time, ability to sit comfortably, and whether the affected limb is needed for driving. Timing varies by clinician and case.

Q: What affects the cost of evaluation and treatment?
Costs vary based on imaging needs, emergency vs outpatient evaluation, hospital vs ambulatory surgery, implant and fixation choices, and rehabilitation requirements. Insurance coverage, region, and facility setting can also change costs. For any individual situation, cost ranges depend on the care pathway.

Q: Can the existing joint replacement be saved?
Sometimes, yes—particularly if the implant is stable and the fracture can be repaired around it. In other cases, revision of one or more components may be considered to restore stability and function. Whether preservation is feasible varies by clinician and case.