title: Management of periprosthetic femoral fractures following total hip arthroplasty: a review.
abstract: OBJECTIVE
  As the number of total hip arthroplasties (THAs) is increasing, the expected number of periprosthetic femur fractures is also expected to increase. As such, a thorough grasp of the evaluation and management of patients with periprosthetic femur fractures is imperative, and discussed in this review.
  
  
  METHODS
  This review discusses the epidemiology, classification, and management of periprosthetic femur fractures in an evidence-based fashion.
  
  
  RESULTS
  Periprosthetic fracture management starts with assessing stem stability and bone quality. Well-fixed stems require fracture fixation without stem revision, while loose stems require revision THA.
  
  
  CONCLUSIONS
  Periprosthetic femoral fractures after primary total hip arthroplasty are a complex and clinically challenging issue. The treatment must be based on the fracture, the prosthesis, and the patient (Table 1). The Vancouver classification is not only helpful in classifying the fractures, but also in guiding the treatment. In general, well-fixed stems require open reduction and internal fixation, whereas loose stems require revision arthroplasty.
authors: Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. abdel.matthew@mayo.edu.
authors: Matthew P
authors: MP
authors: Abdel
authors: Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. cottino.umberto@mayo.edu.
authors: Umberto
authors: U
authors: Cottino
authors: Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. mabry.tad@mayo.edu.
authors: Tad M
authors: TM
authors: Mabry
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005264:Femoral Fractures / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005269:Femur / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal; D006801:Humans; D057068:Periprosthetic Fractures / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012086:Reoperation
keywords: Femur; Periprosthetic fractures; Total hip arthroplasty (THA); Vancouver classification