الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
THA is a highly successful procedure with a high likelihood of excellent long-term results and a relatively low risk of complications. One of the major complications of THA is PPFs. Although both postoperative and intraoperative fractures occur, it is the former that have received the greatest attention in the literature. Despite this, the prevalence of intraoperative periprosthetic fractures is increasing. It is imperative that the modern reconstructive hip surgeon be familiar with the classification and treatment of these complications.
Several patient characteristics may be associated with an increased risk of intraoperative fracture. Female sex and increased age have been suggested to be independent risk factors; however, these factors may be confounded by osteoporosis. Medical comorbidities, in particular rheumatoid arthritis, have been suggested to be risk factors, but they may be similarly confounded by associated osteopenia. Altered bone morphology or deformity, as seen in Paget disease, can also increase the risk of fracture. There is higher risk of intraoperative fracture in the setting of revision THA. The increasing number of revision procedures in older patients introduces the effect of osteopenia, osteolysis, or stress-shielding with subsequent bone defects as well as the presence of stress-risers related to previous procedures.
At present, the Vancouver classification system probably comes closest to the ideal, as it considers the fracture configuration, the stability of the implant and the quality of the bone stock. Management of these fractures is difficult, complex, and expensive, also may be associated with complications and pre-existing co-morbidities commonly seen in older patients. In many cases, the surgeon has to solve the simultaneous problems of implant loosening, bone loss and fracture. A thorough understanding of the unique characteristics of the different fracture types, the principles of PPF treatment and a familiarity with various fixation devices, grafts and prosthetic implants are all of paramount importance.