What Is The Best Way To Treat A Periprosthetic Hip Fracture?

Most periprosthetic hip fractures require surgery, either open reduction and internal fixation (ORIF, a procedure that uses plates, screws, or cables to secure the broken bone). In some cases, surgeons recommend revision hip arthroplasty to replace a loose implant. However, the best treatment depends on the stability of your hip implant and the strength of the surrounding bone tissue.

At Total Orthopedics and Sports Medicine, our surgeon, Dr. Charles Ruotolo, uses detailed imaging to assess the fracture site, implant position, bone fragments, and condition of your hip joint. He uses rigid fixation to secure an implant or performs joint revision surgery when a damaged component needs replacement. Then, we create a structured rehabilitation plan that supports safe movement, bone healing, and a gradual return to daily activities. Call 855-321-6784 to book an appointment in Deer Park.

What Are The Treatment Options For Hip Implant Fractures?

Our surgeon, Dr. Charles Ruotolo, may recommend bracing and limited weight bearing to manage stable, nondisplaced fractures (breaks that have not shifted). However, unstable periprosthetic fractures often require internal fixation or revision arthroplasty to realign the bone and secure the implant. Beyond this, he may use cerclage wiring, bone grafting, intramedullary nailing, acetabular socket revision, or cortical strut allografts to treat complex fractures.

Here is how these procedures support earlier movement and reduce further damage around the hip joint:

Open Reduction And Internal Fixation

If your hip implant is stable, open reduction and internal fixation can secure the broken bone. In this procedure, your surgeon realigns the fracture through an incision, then uses plates, screws, and cables for rigid fixation. This approach keeps the implant in place while the bone heals.

In some cases, your surgeon may use minimally invasive plate osteosynthesis (MIPO), a technique that inserts a plate through small incisions to reduce soft tissue damage while securing the fracture. As a result, you can begin a structured recovery plan after your surgeon confirms early healing.

Moreover, a retrospective study published in MDPI reviewed 53 patients who underwent ORIF for fractures around cementless femoral stems. After an average 4.4-year follow-up, researchers found the following outcomes after surgery:

• Bone healing: 51 patients (96.2%) achieved fracture union within an average of 20.5 weeks
• Revision-free survival: 98.1% did not require revision surgery at five years
• Reoperation-free survival: 94.3% avoided another operation at five years
• Fracture pattern: Vancouver B1 fractures accounted for 84.9% of cases
• Mortality: The one-year rate was 5.7%, while the five-year rate was 22.6%

Cerclage Wiring And Cables

If small bone fragments need extra support, your surgeon may secure them with cerclage wires or cables. These metal bands wrap around the bone to hold the pieces in proper alignment. Surgeons often use this minimally invasive technique for cracks near the greater trochanter (the bony area on the outer upper thigh). It can also prevent the proximal femur from splitting during implant placement.

Bone Grafting

Bone grafting strengthens weak areas around the fracture. During this procedure, your surgeon places donor bone or your own bone at the fracture site to fill gaps and support healing. This added bone tissue rebuilds missing support around bone defects and creates a stronger base for the repair. In most cases, surgeons combine grafting with fixation or revision procedures to achieve added stability.

Intramedullary Nailing

For certain periprosthetic femur fractures, an intramedullary nail can stabilize the thigh bone from within. Your surgeon inserts a metal rod through the center of the femur (thigh bone) to hold the broken sections in alignment. During this process, your surgeon carefully avoids cortical perforation, which occurs when a drill or implant breaches the outer shell of the bone. The rod shares weight across the injured area and protects the repair during early recovery. However, the fracture location and the presence of an existing implant determine your eligibility for intramedullary nailing.

Acetabular Socket Revision

If the acetabular component has moved or damaged the hip socket, your surgeon may replace that part of the implant. He removes the faulty component, then rebuilds the socket with specialized implants sized to address the extent of bone loss. In severe cases, metal cages or larger socket components support the reconstructed area. This procedure restores a stable connection between the hip socket and the artificial joint.

Cortical Strut Allografts

For fractures with multiple bone fragments or poor bone strength, your surgeon may use a cortical strut allograft (a strong piece of processed donor bone). He places the graft along the outer surface of the femur and secures it with cables. The graft acts like a splint, supports the fractured bone fragments, and adds strength to the surgical repair.

In fact, a study published in Archives of Orthopaedic and Trauma Surgery examined 41 patients with Vancouver B1 or C periprosthetic femur fractures. Researchers compared standard internal fixation with fixation plus cortical strut allografts and found better bone union in the allograft group. Their final mRUST score (a measure of bone healing on X-rays) averaged 14.75 with an allograft, compared with 12.25 without one. The study also found reduced surgical failure and no increase in complications or infection.

What Causes A Fracture Around Your Total Hip Replacement?

Falls, direct blows, and a loose implant can break bone around a total hip arthroplasty. Over time, wear or osteolysis (bone loss caused by a reaction to implant debris) can loosen the femoral stem and place extra stress on nearby bone. Osteoporosis, arthritis, and bone tumors can also weaken the femur and increase fracture risk. In addition, older adults and people with multiple medical conditions may face a higher risk of periprosthetic hip fractures.

What Are The Warning Signs of a Hip Implant Fracture?

You may notice sudden severe groin or thigh pain, an inability to bear weight, and a sense that your hip has become unstable. You may also notice your affected hip leg appears shorter, turns outward, or develops swelling and bruising. These symptoms may worsen when you stand, walk, or try to move the injured leg.

In addition, the following warning signs can signal damage to the implant or surrounding bone:

• Mechanical symptoms: New popping, clicking, or grinding sounds occur in the hip joint.
• Severe tenderness: The skin around your hip becomes very sensitive to touch.
• Visible deformity: Your leg or hip has an unusual shape or position.

How Is A Periprosthetic Hip Fracture Diagnosed?

Our hip specialist, Dr. Charles Ruotolo, diagnoses hip implant fracture through a detailed physical examination and high-quality X-rays of the affected hip. These images show the fracture location, severity, and stability of the original implant. In some cases, he orders a CT scan, which creates three-dimensional views of the bone and fracture site.

Our surgeon, Dr. Charles Ruotolo, may also use an MRI to assess nearby muscles, tendons, and other soft tissues. If surgery may be needed, blood tests and an erythrocyte sedimentation rate test check your general health and signs of inflammation. During the examination, our surgeon, Dr. Charles Ruotolo, reviews your medical history and performs the following physical tests to assess hip movement, leg alignment, and implant stability:

• Leg length check: Compares both legs for a visible difference in length
• Hip movement test: Assesses pain or limits during hip motion
• Weight-bearing assessment: Checks whether you can safely stand or walk on the affected hip
• Tenderness check: Identifies painful areas around the hip and upper thigh
• Leg alignment review: Looks for outward rotation, shortening, or a deformed leg
• Nerve function test: Checks sensation and muscle control in the injured leg

How Do Doctors Classify Periprosthetic Hip Fractures?

Doctors use the Vancouver Classification System to group fractures around a hip replacement. This system assesses the break’s location, the stability of the artificial components, and the quality of the surrounding bone. It also shows whether you have a stable implant or need a surgical intervention. As a result, your surgeon can select the safest treatment approach for your fracture pattern.

Here is how the Vancouver Classification System guides your surgeon toward the most suitable treatment approach:

Type A: Trochanteric Fractures

Type A fractures affect the upper femur near the bony areas where muscles attach. These breaks may occur on the outer or inner side of the hip, such as:

• Type AG: A fracture of the greater trochanter (the outer bony part of the upper thigh bone)
• Type AL: A fracture of the lesser trochanter (the inner bony part of the upper thigh bone)

Type B: Fractures Near The Stem

Type B fractures occur around or just below the implant stem and form the most common group. Since implant stability and bone quality can differ, your surgeon classifies these fractures into the following types to select treatment:

• Type B1: The implant remains secure, so fixation can stabilize the broken bone
• Type B2: The implant is loose, but the surrounding bone remains strong enough for a new implant
• Type B3: The implant is loose, and poor bone quality or major bone damage requires complex reconstruction

Type C: Fractures Below The Stem

Type C fractures develop well below the implant stem in the femoral shaft (the long middle part of the thigh bone). These fractures usually have a stable implant and require open reduction and internal fixation (ORIF) to secure the broken bone with plates, screws, or cables. This approach stabilizes the fracture without requiring hip implant replacement.

Can A Periprosthetic Hip Fracture Heal Without Surgery?

Yes, some fractures around a hip implant can heal without surgery. However, your surgeon must first confirm, using X-rays, that the implant stem or cup remains secure and that the bone fragments have not shifted. Once your surgeon confirms your eligibility, they may guide you through the following treatment options to support bone healing and protect the injured hip:

• Rest and Immobilization: You limit movement and avoid pressure on the injured hip so the bone can heal.
• Restricted Weight Bearing: A walker, crutches, or a wheelchair reduces stress on the fracture site.
• Bracing or Splints: A brace can stabilize the hip joint during early recovery.
• Pain Management: Medications or nerve block injections can help manage pain and reduce inflammation.
• Guided Exercises: A doctor guides safe exercises for nearby joints to limit stiffness and muscle weakness.
• Bone Healing Stimulators: Low-intensity ultrasound or electrical stimulation may support bone repair in selected cases.

Moreover, your surgeon schedules regular X-rays, often every 6 to 8 weeks, to check bone healing and implant stability. These visits also detect gradual implant loosening before it causes a serious complication. This close monitoring also helps protect you from problems associated with limited movement, such as blood clots, stiffness, and muscle weakness

How Is A Hip Implant Fracture Treated Surgically?

Surgeons treat a hip implant fracture by stabilizing the broken bone or replacing an unstable implant. However, the exact surgical procedure depends on the fracture location, severity, and condition of the surrounding bone. For example, if the implant remains secure, your surgeon may use plates, screws, or cables to stabilize the bone.

On the other hand, a loose implant or weakened bone may require revision total hip arthroplasty with a longer stem or structural bone graft. In these cases, surgery is often performed within 24 to 48 hours of hospital admission to stabilize the fracture and limit further bone damage. During the procedure, your surgical team usually uses general or regional anesthesia to ensure your comfort throughout the repair.

Note: You should review blood-thinning medications, fasting instructions, and anesthesia plans with your surgical team before surgery.

How Does Bone Quality Affect Your Hip Surgery Plan?

Poor bone quality can reduce the grip that plates and screws need to stabilize a hip fracture. As a result, your surgeon carefully reviews bone strength before selecting the surgical repair. They may use locking plates, longer revision stems, or bone cement to secure the implant in healthier bone. In some cases, your surgeon may use the following bone graft to fill weak areas, improve support, and lower the risk of implant failure:

• Cortical strut allograft: A processed donor-bone piece placed along the femur to support weak bone.
• Cancellous bone graft: Small pieces of donor or your own bone that fill gaps around the fracture.
• Structural bone graft: A larger graft that rebuilds major bone defects and supports the new implant.

When Is Revision Hip Replacement Needed After a Fracture?

Our surgeon, Dr. Charles Ruotolo, recommends revision hip arthroplasty when the femoral stem has loosened or shifted inside the thigh bone. Joint revision involves removing the unstable stem and replacing it with a longer implant that extends beyond the fracture into stronger bone. This new component anchors in healthy bone farther down the femur and improves stability.

In addition, our fellowship-trained surgeon, Dr. Charles Ruotolo, may recommend balance revision surgery in the following situations:

• Loose implant: The hip stem or socket no longer has a secure connection with the bone
• Severe bone loss: Weak or missing bone cannot support the existing implant
• Unstable fracture: The broken bone has shifted or cannot heal in proper alignment
• Repeated dislocation: The artificial hip repeatedly slips out of its normal position
• Deep infection: An infection around the implant requires removal and replacement of components
• Faulty prosthetic parts: A damaged stem, cup, or liner can weaken hip stability and require replacement.

How Does A Multidisciplinary Team Support Hip Fracture Care?

A multidisciplinary team coordinates surgery, medical care, and rehabilitation through a single, clear treatment plan focused on safe injury stabilization. This team approach can reduce complications, shorten your hospital stay, and support a safer return to movement and independence. It also ensures that each specialist addresses a different part of your recovery. For example, the following professionals work together during your hip fracture care:

• Orthopedic surgeon: Repairs the fracture and evaluates your femoral component and ipsilateral femur.
• Anesthesiologist: Provides anesthesia and manages pain during surgery.
• Medical physician: Monitors health conditions, medications, and surgical readiness.
• Rehabilitation specialist: Helps you regain safe movement after surgery using partial weight and balance training.
• Occupational therapist: Guides safer ways to manage daily tasks, especially if you have poor vision or home hazards.
• Nursing team: Monitors your recovery, wound care, and mobility needs in the surgical area.
• Case manager: Arranges home services or transfer to a rehabilitation center.

What Is The Recovery Time After Hip Implant Fracture?

Recovery after hip implant fracture surgery often takes 3 to 6 months for bone healing. However, full functional recovery may take 6 to 12 months as you rebuild strength, mobility, and confidence in daily activities. You may need a hip brace for several weeks post-surgery to protect the joint and surgical area. After this early stage, you may spend several weeks in a rehabilitation center, depending on your recovery needs and home support. As healing progresses, hip surgeon may recommend exercises, such as:

• Ankle pumps: Move your feet up and down to support circulation
• Quadriceps sets: Tighten your thigh muscles while keeping your leg straight
• Gluteal squeezes: Tighten your buttock muscles to build hip support
• Heel slides: Slowly bend and straighten your knee while lying down
• Supported standing: Practice standing safely with a walker or support
• Walking exercises: Gradually improve balance, strength, and mobility

How Can You Lower the Risk of Future Hip Replacement Fractures?

To prevent future hip implant fractures, you should reduce fall risks and use walking aids when recommended. You should also maintain strength through adequate nutrition and prescribed bone health treatments. Beyond that, attend regular orthopedic follow-up visits to monitor implant wear or silent loosening.

In addition, the following preventive measures can help you protect your hip implant and lower the risk of another fracture:

• Keep floors clear: Remove loose rugs, cords, and clutter.
• Improve lighting: Use bright lights, especially near stairs.
• Wear supportive shoes: Choose non-slip, well-fitting footwear.
• Stay active: perform approved balance and strength exercises to safely bear partial weight on the operated leg.
• Review medications: Ask your doctor about medicines that cause dizziness or implant neurological problems.

Book a Consultation With Dr. Charles Ruotolo to Review All Treatment Options for Periprosthetic Hip Fracture!

After a hip implant fracture, you may feel unsure which treatment options will give you the best long-term results. You might worry that delaying care could lead to permanent loss of mobility and independence. Many patients also feel concerned that a short-term fix could overlook underlying problems with the implant or bone and limit their future recovery.

At Total Orthopedics and Sports Medicine, our surgeon, Dr. Charles Ruotolo, guides you through both surgical and non-surgical treatment options based on your fracture severity. Before recommending any treatment, he carefully discusses your recovery goals, current health status, and medical risk factors to match the plan to your individual needs. Throughout your care, he also schedules regular follow-up visits and adjusts your treatment as needed. Call 855-321-6784 or visit our clinic in Deer Park for personalized hip fracture care.

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