The outcome of an otherwise successful total hip arthroplasty is occasionally compromised by complications. Fracture around the femoral stem is a rare but potentially problematic complication of total hip arthroplasty. Such fractures can range from being minor, with minimal or no effect on the outcome, to being catastrophic and possibly creating an unreconstructable problem with an immense effect on the patient's function.

The prevalence of periprosthetic fractures is on the rise. Periprosthetic fractures of the femur are more frequent during arthroplasties performed without cement and following revision total hip arthroplasties. Currently, the prevalence of femoral fractures has been estimated to range from 0.1% to 3.2% for primary total hip arthroplasties without cement and from 3% to 12% for revisions performed with cement1. The introduction of uncemented press-fit stems has resulted in a substantial increase in intraoperative fracture rates, ranging from 3% to 46%1. With the substantial increase in the number of total hip arthroplasties being performed and the growing number of patients with a total hip arthroplasty in place for more than thirty years, the prevalence of periprosthetic fractures is anticipated to rise even further.

The objective of this study was to revisit the treatment algorithm that was first devised by Duncan and Masri2 and present the outcomes of surgical intervention for a variety of fractures of the femur that occurred around total hip prostheses in a relatively large population treated at our institution.

### Demographics

Using our institutional database, we identified all patients who had received treatment for a fracture around the femoral component of a total hip arthroplasty since 1995. Patients who had sustained an intraoperative longitudinal fracture of the proximal part of the femur were excluded from the study, leaving 123 periprosthetic fractures in 110 patients. There were thirty-nine men and seventy-one women with …