The example on the coding of periprosthetic fractures in Coding Clinic, Fourth Quarter 2016, page 42, seems to have an error. Since in periprosthetic fractures “the prosthesis itself is not fractured, the area around the prosthesis is fractured,” shouldn’t the example be of the upper end of the femur instead of the lower end of the femur, or post knee replacement, rather than post hip replacement? Is it possible for a fracture of the lower end of the femur to be around a hip replacement prosthesis?
The example published was based on a real question received by the AHA Central Office and is clinically correct. This periprosthetic femoral fracture was of the Vancouver classification type C, which was well below the prosthesis stem tip. There are several different classifications for periprosthetic femoral fractures around hip prostheses, all of which classify these fractures by the location. One such classification is the Vancouver classification, which is based primarily on the location of the fracture, the quality of fixation of the stem, and the quality of the bone. The Vancouver classification refers to periprosthetic femoral fractures based on the location of the fracture as follows:
- Type A: Trochanteric
- Type B: Around the prosthesis stem tip
- Type C: Well below the prosthesis stem tip