The prevention of periprosthetic fractures in total hip and knee arthroplasty

Periprosthetic fractures in total hip and total knee arthroplasty lead to c onsiderable morbidity in terms of component fixation, bone loss, and subseq uent function. The management of these fractures is technically demanding a nd may result in suboptimal fixation owing to poor bone stock. The preventi on, early recognition, and appropriate management of such fractures are the refore critical. The pathogenesis of periprosthetic factors is multifactori al. There are a number of intrinsic patient influences such as bone stock, biomechanics, and compliance. There are also a host of extrinsic factors ov er which the surgeon has more control. The prevention of periprosthetic fra ctures requires careful preoperative planning and templating, the availabil ity of the necessary expertise and equipment, and knowledge of the potentia l pitfalls so that these can be avoided both intraoperatively and in follow -up.