• OBJECTIVES
    • To define the characteristics of periprosthetic atypical femoral fractures (PAFFs) in patients on long-term bisphosphonate treatment and to provide a guide to the diagnosis and long-term treatment of these patients based on the literature.
  • DESIGN
    • Multicenter retrospective review.
  • SETTING
    • Fifteen orthopaedic centers in the United States and Canada, including members of the Canadian Orthopaedic Trauma Society.
  • PATIENTS/PARTICIPANTS
    • Patients on long-term bisphosphonates who presented with either periprosthetic fractures or femoral fractures, over a 10-year period.
  • MAIN OUTCOME MEASUREMENTS
    • Time to union and complications.
  • RESULTS
    • Clinically significant differences were identified in time to union, mortality, and complications. There was a statistically significant difference in complications. Imaging review demonstrated identical features in both atypical femoral fractures (AFFs) and PAFFs.
  • CONCLUSIONS
    • This is the largest comparative case series reported on PAFFS and AFFs and provides compelling evidence that PAFFs in patients on long-term bisphosphonates are indeed a subset of periprosthetic fractures that exhibit atypical femoral fracture (AFF) characteristics. As such, these fractures pose serious diagnostic and management challenges to trauma and arthroplasty surgeons.
  • LEVEL OF EVIDENCE
    • Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.