Bisphosphonate-Induced Periprosthetic Fracture: A Cause of Painful Total Hip Arthroplasty

Bhattacharyya, Rahul; Spence, Stephanie; O’Neill, Gavin Kane

doi:10.1155/2014/631709

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…callus and disappearing fracture line at 4 months postoperatively, and the patient was able to walk without assistance or thigh pain. Similar cases have been reported (Table 1) [3][4][5][6][7][8][9][10][11][12]. All were females and all had a history of long-term bisphosphonate therapy.…”

Section: D B a B Asupporting

confidence: 77%

Case Report and Literature Review of Periprosthetic Atypical Femoral Fractures After Total Hip Arthroplasty

Kurinomaru

Mori

Tsukamoto

et al. 2019

J UOEH

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We describe a case of periprosthetic femoral fracture with 5 major features of an atypical femoral fracture (AFF) and localized cortical thickening at the fracture site, which is characteristic of an AFF. An 81-year-old female patient had undergone cementless total hip arthroplasty for a right femoral neck fracture at the age of 66, and had been taking oral alendronate since then. At the age of 79, she developed spontaneous right thigh pain. Radiographs showed lateral cortical thickening and pedestal formation around the end of the femoral component. She was advised to discontinue oral alendronate and change to eldecalcitol. At the age of 81, she developed sudden severe pain when standing up from a seated position and was not able to walk. Radiographs showed a periprosthetic femoral fracture with 5 major features of AFF at the site of localized cortical thickening. We diagnosed a Vancouver type B1 periprosthetic femoral fracture. She underwent open reduction and internal fixation (ORIF) with an NCB ® Periprosthetic Femur Plate System with cable grips. Daily subcutaneous injection of teriparatide and low intensity pulsed ultrasound therapy were performed to stimulate bone healing. She was able to walk without assistance at 4 months after ORIF. Radiographs showed adequate bridging callus and a disappearing fracture line. This case was diagnosed as a periprosthetic atypical femoral fracture (PAFF), because a periprosthetic fracture is excluded from the definition of AFF. Similar to AFF, PAFF exhibits poor clinical outcomes. The approach to treating PAFF should be decided after considering the pathogenesis.

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Section: D B a B Asupporting

confidence: 77%

Case Report and Literature Review of Periprosthetic Atypical Femoral Fractures After Total Hip Arthroplasty

Kurinomaru

Mori

Tsukamoto

et al. 2019

J UOEH

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“…Curtin et al reported three cases of incomplete PAFFs treated by discontinuing BPs and limiting weight bearing; later, teriparatide was added to two cases [ 3 ]. Cross et al reported incomplete PAFFs treated by discontinuing BPs, starting teriparatide, and limiting weight bearing [ 4 ], while Bhattacharyya et al reported successful treatment of incomplete PAFFs by only discontinuing BPs and limiting weight bearing [ 8 ]. Lee et al reported preventive osteosynthesis surgery performed for a case in which femoral pain and fracture lines were revealed despite loading restriction and teriparatide administration for incomplete PAFFs [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment

Miura

Kijima

Tani

et al. 2019

Case Reports in Surgery

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The current definition of atypical femoral fractures (AFFs) excludes periprosthetic fractures. However, a few cases of bisphosphonates (BPs) -associated periprosthetic atypical femoral fractures (PAFFs) have been reported in the literature. Here, we report two rare cases of PAFFs that fulfilled the major criteria for AFFs in patients with prolonged use of BPs. Both cases progressed to a complete fracture with minor trauma from an incomplete fracture at the distal tip of the well-fixed femoral stem. The femoral stem effect on lateral femoral cortical bone, together with the decreased bone elastic resistance induced by BPs, was considered the cause of onset. In each case, we performed open reduction and internal fixation using a locking plate with cable grip and postoperatively prescribed teriparatide and low-intensity pulsed ultrasound (LIPUS). Both cases had a good clinical course. However, as conservative treatment was not effective in these cases, treatment such as non-weight-bearing exercises during hospitalization or prophylactic surgery may be necessary. Further studies are needed to determine the optimal treatment strategy.

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“…Their action in preventing fragility fractures can cause a hip's range of motion alteration in a few patients. This can cause micro fractures especially in more mechanical stress sites as the lateral femoral cortex (12,13). In hip prosthesis the femoral stem presence, changing the bone modulus of elasticity, can increase the amount of mechanical stress and promote the occurrence of femoral atypical fractures.…”

Section: Discussionmentioning

confidence: 99%

Histological study of atraumatic periprosthetic fractures: does atypical periprosthetic fracture exist?

Bottai

Paola

Celli

et al. 2017

ccmbm

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SummaryPurpose. Is it possible a correlation between some periprosthetic femoral fractures and atypical fractures? Case. We present a case of a 77-year-old woman with atypical periprosthetic femoral fracture. The patient had a history of long-term bisphosphonate use. We performed an open reduction, a synthesis of the fracture and a histological exam. The patient stopped the bisphosphonate (BF) therapy. Three months later, before starting the teriparatide treatment, the patient had a re-fracture so we did a second osteosynthesis and began a teriparatide therapy. After six months, the radiography showed a bone healing at the fracture site. Result. The histological examination confirmed the diagnosis of atypical femoral fracture. Conclusion. At first, the fracture showed a delayed union which led to a new surgery, as often happens in BF-related atypical fractures. Appropriate treatment (BF suspension and teriparatide beginning) permitted fracture healing. The atypical characteristic of the fracture was confirmed by histological exam. Some periprosthetic femoral fractures in patients treated with BF, especially in long time therapies, should be suspected as atypical fractures and a specific medical treatment should be performed, as well as a correct surgical treatment.

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Bisphosphonate-Induced Periprosthetic Fracture: A Cause of Painful Total Hip Arthroplasty

Cited by 10 publications

References 9 publications

Case Report and Literature Review of Periprosthetic Atypical Femoral Fractures After Total Hip Arthroplasty

Case Report and Literature Review of Periprosthetic Atypical Femoral Fractures After Total Hip Arthroplasty

Two Cases of Periprosthetic Atypical Femoral Fractures in Patients on Long-Term Bisphosphonate Treatment

Histological study of atraumatic periprosthetic fractures: does atypical periprosthetic fracture exist?

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