Nightmare of repeated low-energy periprosthetic femoral fracture in a patient with severe osteoporosis - A lesson learned.

We report an 85-year-old patient with severe osteoporosis who had suffered from multiple episodes of periprosthetic fracture of the femur. Revision fixation with long-spanning cable plate for bisphosphonate-induced atypical periprosthetic femoral fracture was performed. Nonunion and implant failure occurred at 16 months requiring revision surgery using long-stem femoral prosthesis with cable-plate fixation. To further facilitate bone healing, allograft and bone morphogenetic protein (BMP) were added. Eventually bone union was achieved after one year.