Specialist Trauma Care
Peri-Prosthetic Fractures & Trauma
A peri-prosthetic fracture is a break in the bone around an existing hip or knee replacement. These are complex injuries that need a surgeon skilled in both fracture fixation and revision joint replacement, and as an NHS Trauma Lead, Paddy Subramanian manages them regularly.
What is a peri-prosthetic fracture?
As more people live longer, more actively, with joint replacements, fractures around implants are becoming more common, often after a fall. The bone breaks around the stem or components of the replacement, and treatment depends on whether the implant is still securely fixed. These injuries sit at the crossroads of trauma surgery and revision joint replacement, which is why they are best managed by a surgeon who practises both.
Fix or revise? Getting the decision right
If the implant remains well fixed, the fracture can usually be repaired around it with plates, screws and cables. If the implant has loosened, the right answer is revision to a longer stem that bridges the fracture. Making that judgement correctly, and having both options available in one pair of hands, is what determines the outcome. Paddy Subramanian's dual trauma and revision practice means the decision and the operation happen without delay or onward referral.
A broader complex trauma practice
As Trauma Lead within the Royal Free London NHS Foundation Trust, Paddy Subramanian manages complex fractures and injuries every week, working in multidisciplinary teams with a strong emphasis on clinical governance and evidence-based care. Examples range from fractures around hip and knee replacements to tibial plateau and patella fractures requiring fixation.
Urgent assessment
A suspected fracture around a joint replacement should be assessed promptly. Private patients can usually be seen within 24 hours, imaging is arranged quickly, and a clear plan (fixation, revision or non-operative care) is explained before anything is decided together.
Dr Subramanian has been approachable, professional and allowed me to consider what is a major surgery with confidence. All my questions were answered and I felt involved in the decision making. I am now back on my feet with a neat scar. I would recommend him highly to anyone.
Verified Patient
Hip Replacement, Doctify (August 2026)
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