Purpose: Proximal femur fracture occurring at the time of femoral canal preparation or insertion of the femoral component is a recognized complication of primary total hip arthroplasty.

Methods: Two hundred seventy three consecutive primary THAs were reviewed retrospectively for occurrence of intraoperative fracture. 146 cemented femoral components and 127 cementless femoral components were implanted. Intraoperative management of non- or minimally-displaced proximal femur fractures involved placement of either one or two cerclage cables, with postoperative weightbearing to tolerance using an assistive device for approximately six weeks.

Results: Eight (2.9%) hips sustained an intraoperative non- or minimally-displaced fracture of the proximal femur: six (75%) occurred using cementless stems and two (25%) occurred using cemented stems. At an average follow-up of 57 months (R 26–90 months), all patients in the fractured cohort have remained radiographically stable, with well-fixed femoral components showing no evidence of subsidence. All of the patients in this fractured group have achieved good or excellent functional results.

Conclusions: Midterm follow-up results suggest that non- or minimally-displaced proximal femur fractures occurring at the time of primary THA can safely and effectively be managed by placement of single or multiple cerclage cables, and without significant modification of standard postoperative rehabilitation protocols. No compromise in functional outcome has been observed with this treatment method.