Hip & Thigh

What It Is

A periprosthetic fracture is a broken bone that occurs around the implant (the artificial parts) of a total hip replacement. It is a serious complication that most often needs surgery. Although a fracture can happen during the replacement operation, most of these fractures happen either within a few weeks after the operation or years later in a hip replacement that has been working well. Fortunately, these fractures are rare (AAOS, n.d.).

As more people have hip replacements, the number of these fractures is rising (Ramavath et al., 2020). Treating them can be challenging, because patients may be older and may have other medical problems and thinning bones (AAOS, n.d.).

Fracture After Total Hip Replacement Anatomy

Most of these fractures occur around the stem of the metal component placed in the thigh bone (femur). Fractures of the hip socket (acetabulum) are less common (AAOS, n.d.).

Most of these fractures are caused by a fall. They can also be caused by a higher-energy force, such as a direct blow to the side of the hip or a car accident. The quality of the bone and the amount of force involved determine how severe the fracture is (AAOS, n.d.).

Certain factors increase the chance of a fracture, such as having a condition that weakens bone (for example osteoporosis), and things that make a fall more likely, such as poor vision, muscle weakness or poor balance. A loosened femoral stem is a major risk factor. This loosening usually happens over a long time and is most often due to everyday activity. It can also result from thinning of the bone around the implant (osteolysis) or an infection of the hip replacement (AAOS, n.d.).

Reducing Your Risk

Because most of these fractures are caused by falls, preventing falls is an important part of protecting your hip. Muscle weakness and poor balance make a fall more likely (AAOS, n.d.), and NHS advice on preventing falls recommends regular activities that improve strength and balance (NHS, 2025). After a hip replacement, I can help you regain normal movement in the new hip and build up strength and balance in the muscles around it, within your surgical team's precautions. See the My Approach tab for how I work.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

Treatment if a Fracture Does Occur

Most of these fractures need surgery. The surgical team will choose the treatment based on the type and position of the fracture, the quality of the bone, whether the implant is loose and your general health (AAOS, n.d.). Follow your surgical team's own instructions before and after the operation. The main options are:

Open reduction and internal fixation: if the implant is still firmly fixed in the thigh bone, the broken pieces are put back into position and held with screws, cables or metal plates. A bone graft, often donor bone (allograft), may be used to help the bone heal (AAOS, n.d.).
Revision: if the implant stem has loosened, the original implant is removed and replaced with a new one, usually with a longer stem. Donor bone may be used to support weak or missing bone (AAOS, n.d.).

Tips

After surgery you will have some pain. Your doctors and nurses will manage this with medicine prescribed for you, which is an important part of recovery (AAOS, n.d.).
Be careful on unfamiliar paths, slippery pavements and obstacles that could make you trip or fall. Wear shoes or slippers that fit well and have a good grip (NHS, 2025).
Physical therapy usually starts soon after surgery, and your surgeon will tell you how much weight you can put on the leg (AAOS, n.d.).
Regaining your strength and ability to walk may take several months (AAOS, n.d.).
Eat a healthy, balanced diet. Calcium and vitamin D are important for healthy bones (NHS, 2022).
Once your surgical team has cleared you, I can guide you through the exercises. Rehabilitation will not be quick; it can take a few months to get you back to normal.

Treatment

My Approach

A fracture around a hip replacement usually needs surgery, and after that your surgical team's rules come first: how much weight you can put through the leg, and which positions to avoid while it heals. I work inside those rules, and I need your surgeon's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

Early On

Easing the low back, thigh, calf and other leg, and your shoulders if you're on a walker or crutches
Positioning built around your precautions, never taking the hip where you've been told not to
Ankle pumps, gentle thigh and buttock tightening, and the other exercises your team allows

As You're Cleared for More

Scar work once the wound has fully healed
Step-ups, mini-squats, heel raises and balance work, then walking further, cycling or swimming
Strength and balance work kept up long after you feel recovered, and advice on making your home safer, because falls cause most of these fractures

Work near the buttock or hip needs your informed consent and a signed consent form, and no heat goes over the implant. If your leg suddenly looks shorter or turned out, or you have severe new groin, thigh or knee pain, contact your surgeon urgently or go to the emergency room. For calf pain and swelling, chest pain or sudden shortness of breath, call 911.

What to Expect

Typical Course

Typical course: Regaining your strength and ability to walk usually takes several months, at the pace your surgical team sets. Once you're cleared, visits are usually once or twice a week at first, then weekly, then spaced out as you manage more at home.

What I Focus On

Working Within Your Precautions

Compensation Relief

Scar Care

Progressive Strength

Balance & Falls Prevention

Please read

When to See a Doctor First

When to get emergency help

If you have a hip replacement and, after a fall or injury, you have pain around the hip or thigh, swelling or bruising, cannot put weight on the leg, or the leg looks shorter or deformed, call 911 or go to the emergency room at your nearest hospital (AAOS, n.d.).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Fracture after total hip replacement. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/fracture-after-total-hip-replacement/ (Accessed: 7 October 2026).
Ramavath, A., Lamb, J.N., Palan, J. et al. (2020) 'Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes', EFORT Open Reviews, 5(9), pp. 558–567. doi: 10.1302/2058-5241.5.200003
NHS (2025) Falls – prevention. Available at: https://www.nhs.uk/conditions/falls/prevention/ (Accessed: 8 October 2026).
NHS (2022) Osteoporosis – prevention. Available at: https://www.nhs.uk/conditions/osteoporosis/prevention/ (Accessed: 8 October 2026).

Massage therapy · Kitchener–WaterlooFracture After Total Hip Replacement

What It Is

Fracture After Total Hip Replacement Anatomy

Reducing Your Risk

Self-Care & Treatment

Treatment if a Fracture Does Occur

Tips

My Approach

Early On

As You're Cleared for More

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooFracture After Total Hip Replacement

What It Is

Fracture After Total Hip Replacement Anatomy

Reducing Your Risk

Self-Care & Treatment

Treatment if a Fracture Does Occur

Tips

My Approach

Early On

As You're Cleared for More

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Hip Replacement

Compartment Syndrome – Thigh/Buttocks

Developmental Dislocation (Dysplasia) of the Hip (DDH)

Femoral Anteversion

Book a session