case_images: PMC11766882_01
case_images: (A) An anteroposterior radiograph of the pelvis showing osteoporotic bone with a spontaneous femoral neck fracture on the right side (narrow arrow). (B) Cemented hemiarthroplasty was performed, but the patient developed a spontaneous fracture on the contralateral side after 7 days (narrow arrow). (C) A resultant X-ray showing cemented hemiarthroplasty on both sides.
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case_images: One year prior to presentation, she had a spontaneous femoral fracture on the right side, which was treated with a cemented hemiarthroplasty at another hospital, and an additional fracture on the contralateral side one week later, which was also treated with cemented hemiarthroplasty (Figure 1).
case_images: Serial X-rays showing the progression of femoral stem loosening. (A) An X-ray immediately following arthroplasty shows inadequate bone-to-cement fixation. (B) The progressive loosening of the implant 9 months following the index surgery, with impending fracture (narrow arrow), and (C) the resultant periprosthetic fracture at the tip of the cement 12 months following arthroplasty. Notice the thinning of the cortex over time.
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case_images: This structural instability led to bony resorption, which subsequently resulted in a periprosthetic femoral fracture after a minor fall (Figure 2).
case_images: Periprosthetic fracture fixation. (A,B) A long anatomical plate was used with long strut allografts applied to the anterior and posterior sides of the femur. (C,D) The anteroposterior and lateral views of the femur, (E,F) a 3-dimensional reconstruction of the surgery.
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case_images: This meticulous fixation resulted in the secondary stabilization of the cemented stem surrounded by native bone, strut allografts anteriorly and posteriorly, and the plate (Figure 3).
case_images: The axial and sagittal section of the femur showing the secondary stability of the cemented stem. (A) The preoperative CT scan shows a gap between the cortical bone and the cement. (B) Note the thick strut allografts placed anterior and posterior to the fractured femur, providing stability to the intramedullary cement (arrowhead). (C) Bone integration is confirmed, and stem stability was maintained after 18 months. (D) The anteroposterior and lateral views of the femur at 24 months following the operation show the unchanged position of the femoral stem as compared to the immediate postoperative status.
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case_images: X-rays and Computed Tomography (CT) scans confirmed successful integration between the grafted allograft and the native bone and the maintained stability of the cemented stem (Figure 4).