[Periprosthetic femoral fractures: the orthopaedic disease of affluence?]

A total hip prosthesis (THP) is an effective treatment for hip osteoarthritis. Complications like periprosthetic fractures (PPF) are increasing due to an aging population. PPF accounts for 15% of THP revisions in the Netherlands, with rising incidence driven by risk factors such as prior revisions, older age, osteoporosis, falls, and cementless stems. Cemented stems offer a protective factor, particularly in octogenerians. PPF treatment is complex and costly, often requiring surgical intervention through prosthesis revision and/or open reduction and internal fixation (ORIF), both associated with prolonged preoperative workup and higher complication risks. ORIF often remains unregistered, leading to an underestimation of PPF cases. The Vancouver classification aids as treatment guide, though distinguishing stable from unstable fractures remains challenging. Given the high vulnerability of PPF patients, multidisciplinary care including geriatric co-management, significantly improves outcomes. Increasingly, non-operative management is considered, emphasizing shared decision-making to optimize care for this growing patient population.