Periprosthetic Proximal Femoral Fractures: A Comprehensive Review of Epidemiology, Risk Factors, Classification and Management

Periprosthetic proximal femoral fractures (PPFFs) represent an increasingly prevalent complication following hip arthroplasty, driven by global demographic shifts and rising arthroplasty rates. These fractures pose significant clinical and surgical challenges due to their association with implant instability, compromised bone quality, and increased patient morbidity and mortality. The Vancouver classification system remains the cornerstone for fracture classification and management decision-making, distinguishing fractures by location, implant stability, and bone stock quality. This review outlines the epidemiology and risk factors associated with PPFFs, highlighting both patient-related factors, such as advanced age, female sex, osteoporosis, and comorbidities, and implant-related factors, including prosthesis type, fixation method, stem sizing, and surgical approach. Each fracture subtype within the Vancouver classification is discussed, with emphasis on appropriate surgical strategies ranging from conservative management to complex revision arthroplasty. Recent innovations in surgical fixation, including angle-stable and double plating, offer improved biomechanical stability and enhanced union rates. Furthermore, advances in 3D printing and artificial intelligence hold promise for custom implant design and data-driven treatment planning. Novel techniques, such as transprosthetic drilling with internal cooling systems, may further address fixation challenges in complex cases. As the burden of PPFFs continues to grow, a comprehensive understanding of risk stratification, evidence-based treatment, and emerging technologies is essential to improve outcomes and optimize healthcare resource utilization.