1. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fracture of the Femur after Total Hip Arthroplasty. Treatment and Results to Date*† by DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am Volume 79(12):1881-90 December 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

2. Fig. 1 Graph showing the number of postoperative fractures of the femur after ipsilateral total hip arthroplasty at the Mayo Clinic during a twenty-five-year period beginning in 1971. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

3. Fig. 2 Bar graph showing the diagnoses that led to revision total hip arthroplasty at the Mayo Clinic between 1989 and 1993. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

4. Fig. 3-A: Radiograph of a hip that had loosening of the implant, osteolysis, and pain seven years after a total hip arthroplasty. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

5. Fig. 3-B: Three months later, after a misstep, the patient sustained a periprosthetic fracture through an osteolytic defect. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

6. Fig. 4-A Radiograph showing a periprosthetic fracture through an area of cortical perforation and extravasation of cement at the time of a revision total hip arthroplasty. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

7. Fig. 4-B Treatment in the presence of a well fixed stem consisted of insertion of a plate with screws distally and cerclage bands proximally, with bone-grafting of the fracture line and the defect. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

8. Fig. 5 Intraoperative photograph showing onlay cortical strut allograft held with cerclage cables spanning a periprosthetic fracture. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

9. Fig. 6-A Radiograph of a hip with loosening, osteolysis, and a periprosthetic fracture that was neglected because of inadequate medical and radiographic follow-up. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

10. Fig. 6-B: Intraoperative photograph showing replacement of the damaged proximal aspect of the femur with a composite consisting of an allograft and a prosthesis. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

11. Fig. 6-C: The proximal femoral remnants and the trochanter were preserved and secured to the allograft to improve function and stability of the hip. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

12. Fig. 6-D Radiograph showing the final construct. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

13. Fig. 7 Photograph showing a modular proximal femoral replacement stem, which can be useful for the treatment of massive bone loss and a fracture of the proximal part of the femur. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

14. Fig. 8 Radiographs made after ill advised closed treatment, with traction, of a periprosthetic fracture associated with a loose stem. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.

15. Fig. 9 Radiograph made after onlay strut-grafting and use of an extensively porous-coated stem. DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90 ©1997 by The Journal of Bone and Joint Surgery, Inc.