Clin Orthop Surg.  2014 Sep;6(3):358-360. 10.4055/cios.2014.6.3.358.

Spontaneous Acetabular Periprosthetic Fracture in a Patient Continuously Having Zoledronic Acid

• Tantavisut S
• Tanavalee
• Thanakit V
• Ngarmukos
• Wilairatana V
• Wangroongsub Y

• KMID: 1794720
• DOI: http://doi.org/10.4055/cios.2014.6.3.358

Abstract

Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate.

Keyword

Hip arthroplasty; Fracture; Loosening; Zoledronic acid; Bisphosphonate

MeSH Terms

Acetabulum/*injuries/pathology/surgery
Aged
Arthroplasty, Replacement, Hip/*adverse effects
Bone Density Conservation Agents/*adverse effects/pharmacology
Bone Neoplasms/prevention & control/secondary
Bone Remodeling/drug effects
Breast Neoplasms/pathology
Diphosphonates/*adverse effects/pharmacology
Female
Fractures, Spontaneous/chemically induced/etiology
Hip Prosthesis
Humans
Imidazoles/*adverse effects/pharmacology
Osteoarthritis, Hip/*surgery
Periprosthetic Fractures/*chemically induced/etiology
Prosthesis Failure
Reoperation
Bone Density Conservation Agents
Diphosphonates
Imidazoles

Figure

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  Fig. 1 Preoperative radiograph showing the lateral cortex thickening in the subtrochanteric area and osteoarthritic change of the hip.

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  Fig. 2 Immediate postoperative radiograph.

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  Fig. 3 Radiograph (A) and computer tomography scan (B) taken before the revision surgery showing transverse fracture of the acetabulum and loosened acetabular component.

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  Fig. 4 Photomicrograph of the bone from the acetabular fragment at the time of the revision arthroplasty showing complete absence of osteoclastic and osteoblastic activity.

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