It is important to reconstruct a stable hip joint and to achieve rigid stem fixation in the distal fragment. Restoration of leg length, alignment, and rotation are equally important.
The arthroplasty revision should be preferably addressed first to reconstruct a stable hip joint. Internal fixation is then performed to reestablish bone stock.
Note on approaches
The surgeon should use the surgical approach that is the most familiar to him/her for any total hip arthroplasty.
Extensile approach is necessary to access the fracture site for exposure and removal of the prostheses, revision of prostheses, and reduction and placement of fixation devices, such as cerclage wires, cables, strut grafts, or plates for fracture fixation.
2. Revision arthroplasty
Different options are available based on surgeon's preference and classification of periprosthetic fractures: