Periprosthetic fracture following hip resurfacing arthroplasty: treatment guidance using the 'SAVE' classification system.

Abstract

Periprosthetic fracture following hip resurfacing arthroplasty is an uncommon but important complication and represents a distinct failure mode compared with fractures around conventional stemmed total hip arthroplasty. Existing periprosthetic fracture classifications are useful descriptively, but they do not fully address the biomechanical and biological considerations unique to hip resurfacing. Herein, the epidemiology, risk factors, mechanisms of failure, diagnostic workup, classification, and management of periprosthetic fractures following hip resurfacing arthroplasty is presented. Particular emphasis is placed on early femoral neck failure, avascular necrosis, femoral neck notching, varus component positioning, implant stability, adverse local tissue reaction, metal ion assessment, and the role of cross-sectional imaging. The article also proposes the SAVE classification, a treatment-oriented framework incorporating four key domains: Stability of the implant, Anatomical fracture location, Viability of the femoral head-neck segment, and local Environment. The SAVE classification provides a practical framework for determining whether the resurfacing construct can realistically be preserved or whether revision arthroplasty is more appropriate. By linking classification directly to treatment strategy, it may improve consistency in assessment and guide decision-making in these complex injuries.