Results of a Novel Modular Plating System for Periprosthetic Fractures Around the Hip: A Multi-Center Experience

Periprosthetic femoral fractures (PPFFs) around a total or hemi hip arthroplasty present complex fixation challenges, particularly when preserving a well-fixed femoral stem. Traditional laterally based plates may be limited by contouring demands and implant bulk. A novel modular periprosthetic plating system was developed to enhance intraoperative flexibility and anatomic fit. The purpose of this study was to assess clinical and radiographic outcomes of patients who had PPFFs treated with a modular, periprosthetic plating system.

A retrospective cohort study was conducted at two North American Level One trauma centers, including all consecutive adult patients who underwent fixation of a type IV.3-B1, B2, D femoral fracture between 2021 and 2025 using the modular plating system. The primary outcome was fracture union. Secondary outcomes included return to baseline ambulatory function, symptomatic hardware, infection, and hardware failure. Patients were followed until fracture union, reoperation, or a minimum of one year.

There were 32 patients (10 men, 22 women; mean age 77 years, range, 49 to 96) included who had a mean follow-up of one year (range, seven to 34 months). Fracture patterns included Vancouver B1 (56%), B2 (38%), and interprosthetic femoral fractures (6%). There were 16 patients who had a single modular junction, and 16 had both proximal and distal junctions. Overall, 31 of 32 fractures (97%) achieved union without implant-related complications. There was one interprosthetic fracture that developed nonunion with plate bending outside the modular interface, requiring total femoral replacement. Minor complications included distal iliotibial band irritation in three patients (9%) and superficial infection in two (6%), none requiring reoperation.

This modular periprosthetic plating system demonstrated high union rates, no modular junctional failures, and a low reoperation rate. The modular design may offer enhanced versatility and favorable early outcomes for fixation of periprosthetic femoral fractures around the hip.