The PPF Study

@ The Royal Orthopaedic Hospital


The PPF (Periprosthetic Fracture) Study: A national retrospective review of femoral periprosthetic fracture management. Is there variation in practice?

A national collaborative project


Data collection (via REDcap)– April 15, 2021 to August 15, 2021

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The Birmingham Orthopaedic Network (BON) in collaboration with the Birmingham Centre for Observational and Prospective Studies (BiCOPS) have developed a national multicenter service evaluation project to assess the incidence and management strategies of periprosthetic fractures around the femur across the United Kingdom.



As our population is growing older, more primary total arthroplasty procedures are being performed annually. Projection models estimate that periprosthetic fractures are expected to rise by 4.6% every decade over the next 30 years. The rising incidence of femoral periprosthetic fractures presents a clinical burden requiring expert care and an economic impact. The mean cost of treating a single patient with a periprosthetic fracture in a UK teaching hospital was estimated to be £23,469 (range of £615–£223,000).

The true incidence of femoral periprosthetic fractures across the United Kingdom is still vaguely known. The NJR only records cases that underwent revision arthroplasty and does not include cases treated with open reduction internal fixation1. In addition, although various studies describe management options for periprosthetic femoral fractures, there is uncertainty over the indications for fixation or revision. Therefore, standardization of management of periprosthetic fractures should be implemented across the region, but the current evidence for a standardized approach is currently lacking.



The main aim of this study is to report the incidence and mode of fixation of femoral periprosthetic fractures in a large national service evaluation.  The primary observation will be the mode of fixation for each fracture subtype. Secondary measures will evaluate patients’ variables, treatment variables, objective and subjective outcome measures.


Specific objectives:

• To describe the incidence of periprosthetic fractures around the femur

• To highlight variation in the management of femoral periprosthetic fractures

• To identify influential patient and surgical variables on treatment outcomes

• To explore associations between prosthesis and fracture type

• To provide proof of concept data for larger experimental studies


Associated Documents:

Invitation letter


 Template service evaluation registration form

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Instagram: @ppf_study

Twitter: @PpfStudy


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