Periprosthetic Femur Fractures After Total Hip Arthroplasty: Risk Factors and Management Strategies

Background: Periprosthetic femur fractures (PFFs) are increasingly recognized as a significant complication following total hip arthroplasty (THA), particularly as the number of procedures rises. While THA is one of the most successful orthopedic surgeries, PFFs can compromise outcomes and demand complex management. Objective: To review current literature and identify patient- and implant-related risk factors for PFFs, as well as to summarize effective management strategies guided by classification systems. Methods: A structured literature review was conducted using PubMed, focusing on articles published in the past 10 years. Eight peer-reviewed studies were selected based on relevance to femoral fractures post-THA. Data on incidence, risk factors, stem design, and treatment approaches were extracted and synthesized. Results: Key patient-related risk factors include advanced age, female sex, osteoporosis, low body mass index, and certain metabolic conditions. Implant-related risk is elevated with cementless stems, particularly collarless and single-wedge taper designs. The Vancouver Classification system effectively guides treatment: stable fractures (B1) are managed with fixation, while unstable fractures (B2/B3) often require stem revision with cables. High reoperation rates are associated with unstable fractures. Conclusion: Recognition of risk factors and individualized treatment planning is essential for preventing and effectively managing PFFs. Stem design plays a crucial role in fracture risk, and the use of classification systems supports optimal decision-making. Surgical expertise and multidisciplinary coordination are paramount in managing complex cases.