Periprosthetic fractures of the hip and knee in the elderly population are associated with severe comminution due to osteoporosis. Although some of these prostheses can be salvaged by different methods of internal fixation, our experience at Scarborough Health Network, demonstrated that most fractures of the hip were Type B2 or B3 (Vancouver classification) and Type 3 (Lewis/Rorabeck classification) for the knee. These fractures were therefore treated with either a revision long stem with internal fixation or with a proximal femoral resection (hip) and a distal femoral resection and tumour prosthesis for the knee. The few cases that were treated with internal fixation at other institutions failed and were referred to our institution and treated with a revision or a tumour prosthesis. I stress the importance of accurate fracture classification to avoid early failure and the need for revision surgery.

Management of these fractures impose a significant surgical challenge and therefore an experienced surgical team. Accurate classification to avoid failure of treatment and early recognition and management of potential complications is of paramount importance. The management of cases where the tumor prosthesis failed is also becoming more common and salvage of these components less likely to happen.

We, at Scarborough Health Network, present our experience on the management of periprosthetic fractures where internal fixation is not possible, as well as the treatment of periprosthetic fractures where the tumour prosthesis has failed or the integrity of the bone has been compromised beyond salvage. In these extreme circumstances, a total femoral replacement was performed.

Completed MD from the Central University, Quito, Ecuador.

Completed and graduated in Orthopaedic Surgery at the University of Toronto.

2-year Fellowship in trauma and total joint replacement, joint revision surgery at St. Michael’s Hospital

and formerly, Orthopedic and Arthritic Hospital, now known as the Holland Orthopaedic and Arthritic

Hospital, which is part of Sunnybrook Health Science Centre, Toronto, Ontario, Canada.

Senior orthopaedic surgeon and leading hip and knee revision surgeon at the Scarborough Health

Network.

Author of several publications and speaker nationally and internationally.