Periprosthetic Fracture Nonunion

85 year old healthy, independent man, trip and fall 5 years after a total hip arthroplasty and ipsilateral total knee arthroplasty.  He did not have any previous hip pain.
Treated with internal fixation:

Construct failed at one month postoperatively:













Presented to Harborview 8 months after failure, now wheelchair bound. Nonunion was repaired with a locking condylar plate spanning the entire hip prosthesis with secure proximal fixation. At one year follow-up, patient was living independently and ambulating with a cane or walker as needed.


This case highlights the importance of appropriate proximal fixation and the importance of spanning the entire femur in the setting of a perprosthetic fracture.

We have successfully treated a series of these patients with this technique as published in the following article: Isolated locked compression plating for Vancouver Type B1 periprosthetic femoral fractures.

Bryant GK, Morshed S, Agel J, Henley MB, Barei DP, Taitsman LA, Nork SE. Injury. 2009 Nov;40(11):1180-6.

Authored By: Daphne M. Beingessner, M.D.