Periprosthetic fracture of the femur after total hip arthroplasty occurring in winter activities: report of two cases.

Periprosthetic fractures are uncommon after total hip replacement surgery and are most often associated with loosening or osteolysis. In a review of Mayo Clinic records, the cumulative incidence of femoral fractures after primary uncemented prostheses was only 0.4% (4). No periprosthetic fracture associated with sports participation has been previously reported in the literature. When advising patients about return to sports and recreational activities after total hip replacement, concerns fall into two main categories: 1) wear of the bearing surface(s) and secondary ramifications such as early failure or osteolysis, and 2) dislocation or fracture of the prosthesis or periprosthetic bone. The former concerns have been previously examined (5), but the latter have not been reported to date. These case reports describe a complication that may occur in total hip arthroplasty in those patients who return to winter sports and recreational activities. Although at intermediate follow-up there does not appear to have been irreversible damage for these patients, it is imperative to warn patients that activities that place the patient at risk of trauma may compromise the longevity of the artificial joint. This information can be used in helping patients understand the risks associated with athletic activity after total hip arthroplasty, which is a major goal of current recommendations for advising patients after this type of surgery.