Case: Total hip arthroplasty with an uncemented, tapered, fluted stem was performed in a 79-year-old woman with known osteoporosis to treat an intertrochanteric fracture. Exertional thigh pain and cortical thickening developed at the tip of the stem. The patient was treated with teriparatide for a total of 2 years and became asymptomatic within months. Radiographs showed improved bone quality around the stem of the prosthesis, and dual-energy x-ray absorptiometry scans confirmed remineralization.
Conclusion: Stem tip pain is a well-known complication of distally engaging arthroplasty implants. Various surgical options have been suggested to address this condition. Teriparatide is known to help prevent fractures and improve bone healing. This successful off-label use might be of interest for the future treatment of this biomechanical complication.
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