Prophylactic Technique to Reduce the Risk of Interprosthetic Femoral Fractures
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Published:
Oct 27, 2025
Keywords:
Interprosthetic fracture, femoral fracture, prophylaxis
Main Article Content
Abstract
Introduction: With increasing life expectancy and patient longevity, the number of hip and knee arthroplasties has risen, leading to more ipsilateral joint replacements and, consequently, a higher risk of interprosthetic femoral fractures (IFF). The objectives of this study were to evaluate fracture-free survival in patients with ipsilateral hip and knee arthroplasties who had risk factors for IFF and to assess their functional outcomes.
Materials and Methods: Six patients with ipsilateral hip and knee arthroplasties were evalu- ated, all operated on by the same surgical team. The mean follow-up was 46.5 months. Risk factors for interprosthetic fractures included stemmed prostheses, advanced age, osteoporosis, distance between stems <8 cm, revision surgery, and obesity. At the time of arthroplasty, minimally invasive osteosynthesis with a locking plate was performed as a prophylactic measure.
Results: No cases of interprosthetic fracture, infection, loosening, or revision were observed. The rehabilitation protocol was not modified.
Conclusion: Although few studies have addressed interprosthetic fractures, and their results are heterogeneous, they consistently highlight the same risk factors. We believe that prophylactic osteosynthesis entails low intraoperative morbidity and mortality and provides satisfactory short-term outcomes.
Materials and Methods: Six patients with ipsilateral hip and knee arthroplasties were evalu- ated, all operated on by the same surgical team. The mean follow-up was 46.5 months. Risk factors for interprosthetic fractures included stemmed prostheses, advanced age, osteoporosis, distance between stems <8 cm, revision surgery, and obesity. At the time of arthroplasty, minimally invasive osteosynthesis with a locking plate was performed as a prophylactic measure.
Results: No cases of interprosthetic fracture, infection, loosening, or revision were observed. The rehabilitation protocol was not modified.
Conclusion: Although few studies have addressed interprosthetic fractures, and their results are heterogeneous, they consistently highlight the same risk factors. We believe that prophylactic osteosynthesis entails low intraoperative morbidity and mortality and provides satisfactory short-term outcomes.
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How to Cite
Segura, B., Maletti, P., Aguilera, M., Torres, M., Schmir, B., Segura, D., & Silvano, R. E. (2025). Prophylactic Technique to Reduce the Risk of Interprosthetic Femoral Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(5), 457-463. https://doi.org/10.15417/issn.1852-7434.2025.90.5.1771
Section
Clinical Research
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References
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13. Sah AP, Marshall A, Virkus WV, Estok DM 2nd, Della Valle CJ. Interprosthetic fractures of the femur. Treatment with a single-locked plate. J Arthroplasty 2010;25(2):280-6. https://doi.org/10.1016/j.arth.2008.10.008
14. Hoffmann MF, Lotzien S, Schildhauer TA. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury 2016;47(4):934-8. https://doi.org/10.1016/j.injury.2015.12.026
15. Stoffel K, Sommer C, Kalampoki V, Blumenthal A, Joeris A. The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 2016;136(4):553-61. https://doi.org/10.1007/s00402-016-2407-y
16. Platzer P, Schuster R, Luxl M, Widhalm HK, Eipeldauer S, Krusche-Mandl I, et al. Management and outcome of interprosthetic femoral fractures. Injury 2011;42(11):1219-25. https://doi.org/10.1016/j.injury.2010.08.020
17. Zlowodzki M, Williamson S, Cole PA, Zardiackas LD, Kregor PJ. Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures. J Orthop Trauma 2004;18(8):494-502. https://doi.org/10.1097/00005131-200409000-00004
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https://doi.org/10.2106/JBJS.RVW.22.00080
19. Tibbo ME, Limberg AK, Gausden EB, Huang P, Perry KI, Yuan BJ, et al. Outcomes of operatively treated
interprosthetic femoral fractures. Bone Joint J 2021;103-B(7 Supple B):122-8. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2275.R1
20. Tosounidis TH, Giannoudis PV. Osteosynthesis of interprosthetic fractures: Evidence and recommendations. Injury 2018;49(12):2097-9. https://doi.org/10.1016/j.injury.2018.11.011
21. Weiser MC, Lavernia CJ, Kummer FJ. The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur. J Bone Joint Surg Br 2014;96-B(10):1378-84. https://doi.org/10.1302/0301-620X.96B10.33741
22. Mühling M, Sandriesser S, Glowalla C, Herrmann S, Augat P, Hungerer S. Risk of interprosthetic femur fracture is associated with implant spacing—A biomechanical study. J Clin Med 2023;12(9):3095. https://doi.org/10.3390/jcm12093095
23. Bonnevialle P, Marcheix PS, Nicolau X, Arboucalot M, Lebaron L, Chantelot C. Interprosthetic femoral fractures: Morbidity and mortality in a retrospective, multicenter study. Orthop Traumatol Surg Res 2019;105(4):579-85. https://doi.orf/10.1016/j.otsr.2018.07.02
24. Pica G, Liuzza F, Ronga M, Meccariello L, De Mauro D, Amarildo Smakaj A, et al. Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly? Orthop Rev 2022;14(6):38558. https://doi.org/10.52965/001c.38558
25. Romeo NM, Firoozabadi R. Interprosthetic fractures of the femur. Orthopaedics 2018;41(1):e1-e7.
https://doi.org/10.3928/01477447-20170727-01
26. Rao BM, Stokey P, Tanios M, Liu J, Ebraheim NA. A systematic review of the surgical outcomes of interprosthetic femur fractures. J Orthop 2022;33:105-11. https://doi.org/10.1016/j.jor.2022.07.013
27. Hou Z, Moore B, Bowen TR, Irgit K, Matzko ME, Strohecker KA. Treatment of interprosthetic fractures of the femur. J Trauma 2011;71(6):1715-9. https://doi.org/10.1097/TA.0b013e31821dd9f1
28. Kampshoff J, Stoffel KK, Yates PJ, Erhardt JB, Kuster MS. The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. Arch Orthop Trauma Surg 2010;130(5):627-32. https://doi.org/10.1007/s00402-009-0952-3
2. Scolaro JA, Schwarzkopf R. Management of interprosthetic femur fractures. J Am Acad Orthop Surg 2017;25(4):e63-e69. https://doi.org/10.5435/JAAOS-D-15-00664
3. Solarino G, Vicenti G, Moretti L, Abate A, Spinarelli A, Moretti B. Interprosthetic femoral fractures - A challenge of treatment. A systematic review of the literatura. Injury 2014;45(2):362-8. https://doi.org/10.1016/j.injury.2013.09.028
4. Rozell JC, Delagrammaticas DE, Schwarzkopf R. Interprosthetic femoral fractures: management challenges. Orthop Res Rev 2019;11:119-28. https://doi.org/10.2147/ORR.S209647
5. Loucas M, Loucas R, Safa Akhavan N, Fries P, Dietrich M. Interprosthetic femoral fractures surgical treatment in geriatric patients. Geriatr Orthop Surg Rehabil 2021;12:21514593211013790. https://doi.org/10.1177/21514593211013790
6. Santos Pires RE, Barbosa de Toledo Lourenço PR, Labronici PJ, Rosa da Rocha L, Balbachevsky D, Ramiro Cavalcante F, et al. Interprosthetic femoral fractures: proposed new classification system and treatment algorithm. Injury 2014:45 Suppl 5:S2-6. https://doi.org/10.1016/S0020-1383(14)70012-9
7. Mamczak CN, Gardner MJ, Bolhofner B, Borrelli J Jr, Streube PN, Ricci WM. Interprosthetic femoral fractures. J Orthop Trauma 2010;24(12):740-4. https://doi.org/10.1097/BOT.0b013e3181d73508
8. Albareda J, Gómez J, Ezquerra L, Blanco N. Fracturas interprotésicas femorales. Tratamiento con placa lateral de estabilidad angular. Rev Esp Cir Ortop Traumatol 2016;61(1):1-7. https://doi.org/10.1016/j.recot.2016.09.002
9. Neitzke CC, Coxe FR, Chandi SK, Belay ES, Sculco PK, Chalmers BP, et al. High rate of unplanned reoperation for interprosthetic femur fractures after total hip and knee arthroplasty. J Arthroplasty 2024;39(10):2607-14. https://doi.org/10.1016/j.arth.2024.05.018
10. Michila YM, Spalding L, Holland JP, Deehan DJ. The complex problem of the interprosthetic femoral fracture in the elderly patient. Acta Orthop Belg 2010;76(5):636-43. PMID: 21138219
11. Kenny P, Rice J, Quinlan W. Interprosthetic fracture of the femoral shaft. J Arthroplast. 1998;13(3):361-4. https://doi.og/10.1016/s0883-5403(98)90187-5
12. Ebraheim N, Carroll T, Moral MZ, Lea J, Hirschfeld A, Liu J. Interprosthetic femoral fractures treated with locking plate. Int Orthop 2014;38(10):2183-9. https://doi.org/10.1007/s00264-014-2414-y
13. Sah AP, Marshall A, Virkus WV, Estok DM 2nd, Della Valle CJ. Interprosthetic fractures of the femur. Treatment with a single-locked plate. J Arthroplasty 2010;25(2):280-6. https://doi.org/10.1016/j.arth.2008.10.008
14. Hoffmann MF, Lotzien S, Schildhauer TA. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury 2016;47(4):934-8. https://doi.org/10.1016/j.injury.2015.12.026
15. Stoffel K, Sommer C, Kalampoki V, Blumenthal A, Joeris A. The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 2016;136(4):553-61. https://doi.org/10.1007/s00402-016-2407-y
16. Platzer P, Schuster R, Luxl M, Widhalm HK, Eipeldauer S, Krusche-Mandl I, et al. Management and outcome of interprosthetic femoral fractures. Injury 2011;42(11):1219-25. https://doi.org/10.1016/j.injury.2010.08.020
17. Zlowodzki M, Williamson S, Cole PA, Zardiackas LD, Kregor PJ. Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures. J Orthop Trauma 2004;18(8):494-502. https://doi.org/10.1097/00005131-200409000-00004
18. McMellen CJ, Romeo NM. Interprosthetic femur fractures: A review article. JBJS Rev 2022 (9):e22.00080.
https://doi.org/10.2106/JBJS.RVW.22.00080
19. Tibbo ME, Limberg AK, Gausden EB, Huang P, Perry KI, Yuan BJ, et al. Outcomes of operatively treated
interprosthetic femoral fractures. Bone Joint J 2021;103-B(7 Supple B):122-8. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2275.R1
20. Tosounidis TH, Giannoudis PV. Osteosynthesis of interprosthetic fractures: Evidence and recommendations. Injury 2018;49(12):2097-9. https://doi.org/10.1016/j.injury.2018.11.011
21. Weiser MC, Lavernia CJ, Kummer FJ. The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur. J Bone Joint Surg Br 2014;96-B(10):1378-84. https://doi.org/10.1302/0301-620X.96B10.33741
22. Mühling M, Sandriesser S, Glowalla C, Herrmann S, Augat P, Hungerer S. Risk of interprosthetic femur fracture is associated with implant spacing—A biomechanical study. J Clin Med 2023;12(9):3095. https://doi.org/10.3390/jcm12093095
23. Bonnevialle P, Marcheix PS, Nicolau X, Arboucalot M, Lebaron L, Chantelot C. Interprosthetic femoral fractures: Morbidity and mortality in a retrospective, multicenter study. Orthop Traumatol Surg Res 2019;105(4):579-85. https://doi.orf/10.1016/j.otsr.2018.07.02
24. Pica G, Liuzza F, Ronga M, Meccariello L, De Mauro D, Amarildo Smakaj A, et al. Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly? Orthop Rev 2022;14(6):38558. https://doi.org/10.52965/001c.38558
25. Romeo NM, Firoozabadi R. Interprosthetic fractures of the femur. Orthopaedics 2018;41(1):e1-e7.
https://doi.org/10.3928/01477447-20170727-01
26. Rao BM, Stokey P, Tanios M, Liu J, Ebraheim NA. A systematic review of the surgical outcomes of interprosthetic femur fractures. J Orthop 2022;33:105-11. https://doi.org/10.1016/j.jor.2022.07.013
27. Hou Z, Moore B, Bowen TR, Irgit K, Matzko ME, Strohecker KA. Treatment of interprosthetic fractures of the femur. J Trauma 2011;71(6):1715-9. https://doi.org/10.1097/TA.0b013e31821dd9f1
28. Kampshoff J, Stoffel KK, Yates PJ, Erhardt JB, Kuster MS. The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. Arch Orthop Trauma Surg 2010;130(5):627-32. https://doi.org/10.1007/s00402-009-0952-3