Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management

Intraoperative periprosthetic fractures are becoming more common given the increased prevalence of revision total hip arthroplasty and increased use of cementless fixation. Risk factors for intraoperative periprosthetic fractures include the use of minimally invasive techniques; the use of press-fit cementless stems; revision operations, especially when a long cementless stem is used or when a short stem with impaction allografting is used; female sex; metabolic bone disease; bone diseases leading to altered morphology such as Paget disease; and technical errors at the time of the operation. Appropriate treatment of intraoperative periprosthetic fractures does not compromise the long-term results of total hip arthroplasty unless the bone damage precludes stable fixation of the implant.