Fracture after Total Hip Replacement

After a hip replacement, it’s possible for the bone right around the artificial hip to break. Doctors call this a periprosthetic fracture (“peri” means around, “prosthetic” means the implant). These breaks are showing up more often simply because more people have hip replacements and many stay active later in life. A fracture like this can happen during the original surgery, but more often it happens years later, usually after the implant has slowly loosened from normal wear. These breaks tend to be very painful and can be a serious complication. Often these patients are unable to put weight on the leg, and they almost always need surgery to resolve the issue. This page explains why they happen, how they’re treated, and what to expect.

X-ray showing a total hip replacement surgery.

What is a periprosthetic fracture:

This injury is a broken bone around an existing hip implant. The break can be in the socket part of the hip (in the pelvis) or, more commonly, in the thigh bone where the implant’s stem sits. A few different things can cause it:

• A loosened implant. Most of these fractures happen years after the original surgery. As the implant slowly loosens from wear, the bone around it weakens and becomes easier to break.
• Weak bone. Conditions like osteoporosis (thinning, brittle bone) make fractures much more likely, both during and after surgery.
• A break during surgery itself. Sometimes the bone cracks while the surgeon is preparing it or fitting the implant. This is more common during a second (revision) surgery, in people with weak bone, or if too much force is used.

Things that raise a person’s risk include older age, having had a previous hip revision surgery, brittle / weak bones, and trauma or a fall.

When should you consider surgery:

For most of these fractures, surgery isn’t optional. The injury is a unstable one that is not likely to heal well without a revision operation. People usually have severe hip pain, can’t put weight on the leg, and may notice the leg looks shorter or twisted out of position. These are serious enough that most people end up in the emergency room and are admitted to the hospital for surgery.

However, not every break needs an operation. A small and stable fracture can sometimes be treated without surgery, by limiting how much weight you put on the leg while it heals. This is one where the pieces haven’t shifted and the implant is still well secured in the hip bones. Your surgeon decides based on where the break is, how bad it is, and whether the implant is still firmly in place.

What happens during surgery:

The way we repair this injury depended on the pattern of the broken bone, how stable the implants are, and how serious it is. There are many options and variable to consider. In general, the surgeon’s goal is to put the bone pieces back together and make sure the implant is stable. To do that, they may:

• Hold and stabilize the broken bone with metal plates, screws, wires, or cables.
• Replace the implant if it has loosened or is no longer well supported. This often mean swapping it for one with a longer stem that reaches past the break for better stability.
• Rebuild lost bone with a bone graft (extra bone used to fill in and strengthen weak areas), if a lot of bone was damaged.

Using a combination of these three principles of surgery, we will reconstruction the broken bone into a stabilized hip replacement. These are long complex surgeries, and no two cases are the same. They require specialized tools and implants that are more involved than a standard hip replacement.

What does recovery look like:

Recovery from one of these fractures usually takes longer than recovery from the original hip replacement, and the hospital stay tends to be longer as well. Many people who get these fractures are older and have other health conditions, which sometimes need to be stabilized before they’re even ready for surgery. After the operation, recovery centers on physical therapy to rebuild strength and movement, along with managing pain. Your surgeon will set a plan for how soon and how much you can put weight on the leg, and that timeline varies a lot from person to person depending on the type of break and how it was fixed. Some stable fractures are able to put weight on the leg immediately after surgery. However, more unstable injuries often require a period where no weight can be placed on the leg. Most fractures will heal enough by 6-8 weeks that they can tolerate more aggressive weight bearing and rehabilitation. Many patients are relatively pain free, mobile, and back to base line function around 3 months after surgery. However, full recovery can take a year.

What are the major risks and complications:

Repairing one of these fractures is a bigger operation than the first hip replacement, so it carries real risks worth understanding:

• A difference in leg length between the two legs.
• Blood clots in the leg, which can be dangerous if they travel to the lungs.
• Infection, at the wound or deeper around the implant. This may necessitate further surgery
• Blood loss during surgery.
• Nerve injury near the surgical area.
• The bone failing to heal properly (called non-union) or breaking again after the repair.

Your surgeon can walk you through how these apply to your specific situation.

What if you don’t have surgery:

For a small and stable fracture, careful non-surgical treatment can be a reasonable choice. This involves mainly limiting weight on the leg while it heals. Your surgeon will have to monitor it closely. But for the more common unstable fractures, leaving it untreated isn’t really a viable option. The leg can’t bear weight, the bone won’t line up, the break is unstable and heal on its own. This means the pain, instability, and deformity continue. Putting off needed surgery generally means staying off the leg and in pain while the underlying problem stays unresolved. The right path depends on the exact fracture, and it’s a decision to make with your orthopedic surgeon. The good news is that hip replacements are very successful overall, and fractures like this remain uncommon.