08/15/2026
I’d been an attending for one month when this X-ray came through.
Periprosthetic femur fracture below a cemented stem, with failed fixation around it. Multiple prior surgeries. Fragile bone. I called three surgeons who had done this before, and one of them told me I’d get one attempt.
Seven hours: removal of all hardware, extended trochanteric osteotomy to get the cement out, revision stem, cerclage and a long plate to rebuild around it.
The part that didn’t go as planned was an iatrogenic greater trochanter fracture, which meant more fixation than I’d planned for. And I still don’t love the final X-ray — the stem sits close to the anterior cortex. Today I’d consider a femur-spanning plate, or fixing distally and leaving the trochanter alone.
The fracture healed. Four years later she’s walking. Some pain, no further surgery.
I’m a community hip and knee surgeon, not in an academic center. Plenty of surgeons handle harder cases than this. It’s just the hardest one I’ve had given my situation and what I knew at that time.
The patient gave permission for this case and these images to be shared.
