A periprosthetic fracture is a break in the bone surrounding a hip or knee implant, most often caused by falls, weakened bone density, implant loosening, or arthroplasty cement failure. These fractures can be complex because they occur near a joint replacement and may affect implant stability. This article explains common causes, symptoms, diagnostic imaging, and treatment options including nonsurgical care, fixation techniques, and revision surgery. It also outlines the recovery process, the role of physical therapy, and when patients should seek evaluation after experiencing new pain or difficulty bearing weight following joint replacement.
A periprosthetic fracture is a broken bone that occurs around an orthopedic implant, such as a hip or knee replacement. While this type of fracture is less common than typical bone breaks, it can be more complex, especially for aging adults. Unlike a routine fracture, a periprosthetic fracture happens near a joint that has already been surgically replaced. It often requires specialized treatment to protect both the implant and the surrounding bone.
These fractures most frequently occur in the femur (thigh bone) after hip replacement surgery, but they can also happen around knee implants or other types of arthroplasty (joint replacement). The good news is that with timely evaluation and expert care, most patients can recover well and return to their daily activities.
What Causes a Periprosthetic Fracture?
The most common cause of a periprosthetic fracture is a fall, especially in older adults. These injuries often occur when someone with a previous joint replacement loses balance and lands hard on the affected limb.
But a fall isn’t always the only factor. Some patients are more at risk due to:
Osteoporosis or weakened bone density
Previous fractures or surgeries on the same limb
Implant loosening or wear over time
Sudden twisting or high-impact trauma
In some cases, an arthroplasty cement fracture can also contribute to the problem if the material around the implant begins to crack or break down.
If you’ve had a joint replacement and experience a sudden increase in pain, it is important not to ignore it. A fracture after hip replacement surgery or knee replacement may not always be obvious right away.
Common symptoms of a knee or hip fracture include:
Sudden sharp pain near the site of your implant
Difficulty standing, walking, or bearing weight
Swelling or bruising around the joint
Feeling or hearing a “crack” or “pop” at the time of injury
Visible deformity in the leg or joint area
Many patients mistake these symptoms for a pulled muscle or strain, but if you have had a joint replaced, you should treat new or worsening symptoms as urgent. A cracked bone in the hip, for example, may not always show dramatic outward signs but can still be serious.
Diagnosing Periprosthetic Fractures
Getting an accurate diagnosis quickly is key. At SCOI, our joint specialists use a combination of advanced imaging and clinical evaluation to determine the type and severity of the fracture. This may include:
X-rays to view the bone and implant position
CT scans to examine small or complex fractures
A review of your implant history to assess stability
A timely evaluation helps determine whether the implant itself is still stable and if surgical repair is needed. In some cases, the implant remains well-fixed, and only the surrounding bone needs to be addressed.
Treatment Options: When Is Surgery Necessary?
Treatment for a periprosthetic fracture depends on the location, severity, and type of implant involved. In general, treatment goals are to restore bone strength, protect the implant, and regain mobility as soon as safely possible.
Common treatment options include:
Nonsurgical management (for minor or nondisplaced fractures)
Open reduction and internal fixation (ORIF): Using plates, screws, or rods to stabilize the bone
Revision surgery: In cases where the implant is loose or damaged, it may need to be replaced
Bone grafting or augmentation if the bone quality is poor
Surgery is more often required when the fracture compromises the implant’s stability. The good news is that modern surgical techniques make recovery possible even for older adults with multiple health concerns.
Recovery and Rehabilitation
Recovery from a periprosthetic fracture can take time, but with a strong plan and support, most patients return to a full and active lifestyle. Physical therapy plays a central role, focusing on:
Regaining strength and mobility
Improving balance to prevent future falls
Protecting the new surgical repair while healing occurs
Close monitoring during the recovery process by both your surgeon and therapists helps avoid complications and ensures you are healing properly. At SCOI, our team tailors each rehab plan to the patient’s age, health status, and personal goals.
When To Call a Specialist
If you’ve had a hip or knee replacement and suddenly experience pain or instability, don’t wait. A periprosthetic fracture is serious, but with early diagnosis and the right care, you can recover successfully.
Schedule a timely evaluation with Dr. Reddy and the joint specialists at SCOI. Our experienced orthopedic team is here to help you stay active, independent, and comfortable.
If you’ve had a joint replacement and experience a sudden increase in pain, it is important not to ignore it. A 