Periprosthetic and Peri-implant Fractures Differential Diagnoses

Updated: Apr 04, 2023
  • Author: Steven I Rabin, MD, FAAOS; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Diagnostic Considerations

Diagnosis of periprosthetic fractures is generally straightforward. As with any fracture, there is usually a traumatic event, and the trauma is the cause of the fracture.

One cause of fractures around an implant without a specific traumatic event is a stress fracture. On the tibial side of total knee arthroplasties (TKAs), both Ozdemir et al [41] and Fonseca et al [42] reported stress fractures, whereas Wada et al [43] reported stress fractures on the femoral side. Similarly, stress fractures around the femoral stem of hip replacements have been reported by Eschenroeder et al [44] and by Lotke et al, [45]  with insufficiency fractures of the acetabulum also reported by Kanaji et al. [46]

Stress fractures around fixation implants can also occur, as reported by Nagoshi et al [47] after internal fixation of a radial shaft with a titanium plate.

Another cause of fracture around an implant without a specific traumatic event is the atypical insufficiency fracture related to bisphosphonate use. [48, 49, 50, 51]