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Acute Postoperative Bisphosphonate-Associated Atypical Periprosthetic Femoral FractureA Case Report
Christopher W. Reb, DO1; James A. Costanzo, MD2; Carl A. Deirmengian, MD3; Gregory K. Deirmengian, MD3
1 Department of Orthopedics, University of Medicine and Dentistry, New Jersey School of Osteopathic Medicine, 42 East Laurel Road, UDP 3900, Stratford, NJ. 08084. E-mail address: Christopher.Reb@gmail.com
2 Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 810, Philadelphia, PA 19107. E-mail address: jcost2@gmail.com
3 Rothman Institute of Orthopaedics, Thomas Jefferson University Medical School, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for C.A. Deirmengian: deirmenc@gmail.com. E-mail address for G.K. Deirmengian: Gregory.deirmengian@rothmaninstitute.com
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Investigation performed at Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Aug 28;3(3):e85 1-5. doi: 10.2106/JBJS.CC.M.00022
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Periprosthetic bisphosphonate-associated atypical femoral fractures (AFFs) are rare1,2. Recent reports illustrate the need to consider AFF as a cause of hip pain in osteoporotic patients who have been treated with bisphosphonates and have undergone total hip arthroplasty1,3. We report the case of an atraumatic nondisplaced bisphosphonate-associated AFF that manifested three weeks after primary total hip arthroplasty. Retrospective review of the preoperative images showed subtle cortical hypertrophy at the lateral subtrochanteric cortex. By the three-week postoperative visit, the lesion had rapidly progressed to a unicortical fracture. This was treated with immediate femoral revision with a long-stemmed component that achieved fixation distal to the fracture. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
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