Management of periprosthetic hip fractures: current status and prospects; experience of the traumatology and orthopedics department of Mohammed VI University Hospital, Marrakech.


Brahim Demnati
El mehdi Boumediane
Fahd Idarrha
Siham Dkhissi
Mohamed Amine Benhima
Imad Abkari
Mohamed Rafai
Mohamed Rahmi


Introduction: The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol.

Aim: To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them.

Methods: This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included.

Result: Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%).  We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients.

Conclusion: These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.



Periprosthetic fracture , total hip replacement, management , care, Vancouver classification , Morocco



  1. Hamadouche M. Outils d’évaluation clinique des arthroplasties totales de hanche. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur 2006;92(6):581–9.
  2. Chakravarthy J, Bansal R, Cooper J. Locking plate osteosynthesis for Vancouver Type B1 and Type C periprosthetic fractures of femur: A report on 12 patients. Injury 2007;38(6):725–33.
  3. Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H. Mortality After Periprosthetic Fracture of the Femur: The Journal of Bone and Joint Surgery-American Volume 2007;89(12):2658–62.
  4. Bonnomet F, Ehlinger M, Molina V, Thomazeau H. Periprosthetic fractures around total hip and knee arthroplasty. Classification of femoral fractures on a prosthetic hip. Rev Chir Orthop Reparatrice Appar Mot 2006;92(5 Suppl):2S51-6.
  5. Perrin A, Saab M, Chantelot C. Épidémiologie des fractures fémorales péri-prothétiques autour de la hanche. Étude prospective multicentrique de 39 cas, morbimortalité après remise en charge précoce. Rev Chir Orthopédique Traumatol 2016;102(7):S103.
  6. Lindahl H, Malchau H, Odén A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br volume 2006;88-B(1):26–30.
  7. Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H, et al. Treatment and outcomes of 11 Vancouver type B periprosthetic femoral fractures: a retrospective study of 97 cases. The Bone & Joint Journal 2020;102-B(3):293–300.
  8. Sellan ME, Lanting BA, Schemitsch EH, MacDonald SJ, Vasarhelyi EM, Howard JL. Does Time to Surgery Affect Outcomes for Periprosthetic Femur Fractures? J Arthroplasty 2018;33(3):878–81.
  9. Puranik HG, Mukartihal R, Patil SS, Dhanasekaran SR, Menon VK. Does Femoral Notching During Total Knee Arthroplasty Influence Periprosthetic Fracture. A Prospective Study. J Arthroplasty 2019;34(6):1244–49.
  10. Zuurmond RG, van Wijhe W, van Raay JJAM, Bulstra SK. High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases. Injury 2010;41(6):629–33.
  11. Neumann D, Thaler C, Dorn U. Management of Vancouver B2 and B3 femor al periprosthetic fractures using a modular cementless stem without allografting. International Orthopaedics (SICOT) 2012;36(5):1045–50.
  12. Montalti M, Pilla F, Guerra G, Traina F. Periprosthetic Femoral Fractures: Treatments and Outcomes. An Analysis of 47 Cases. HIP International 2013;23(4):380–85.
  13. Mukundan C, Rayan F, Kheir E, Macdonald D. Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients. International Orthopaedics (SICOT) 2010;34(4):485–89.
  14. O’Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br volume.2005;87-B(12):1617–21.
  15. Kinov P, Volpin G, Sevi R, Tanchev PP, Antonov B, Hakim G. Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: Our institutional experience. Injury 2015;46(10):1945–50.