[Treatment of proximal periprosthetic femoral fractures : Options for revision arthroplasty].

Due to the increasing numbers of implantations by total hip arthroplasty and the simultaneous aging of the population, in many countries the prevalence of periprosthetic fractures (PPF) is increasing. Older people with corresponding comorbidities are particularly affected. The frequent cause is low-energy trauma in the sense of a stumbling fall. The surgical treatment in orthopedics and trauma surgery is challenging. It cannot be compared with an elective shaft exchange or a solitary osteosynthesis. The combination of a vulnerable patient group and complex surgical procedures results in operations that are associated with high complication and mortality rates. Therefore, patients must be preoperatively prepared in the best possible way and these must also be performed with the least possible stress for the patient. The aim of this review article is to describe the risk factors of these injuries based on the current literature. The aspects of preoperative preparation, the classification of the fractures and the options for surgical treatment of Vancouver B2 and Vancouver B3 fractures are presented. The selection of implants and the form of fixation of the revision prostheses are also included. It is decisive that the approach is protective with respect to muscle tissue and results in a stable postoperative implant as patients are often cognitively not in a position to carry out partial weight bearing. Furthermore, aspects of postoperative aftercare, possible complications and prevention are described.