{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:47Z","timestamp":1787755547929,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Case Connector"],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>We report on 2 patients with atypical femur fractures that initially presented as painful total knee arthroplasties. There was a history of long-term bisphosphonate use in each case. Knee radiographs and laboratory studies were normal, and the patients were managed conservatively. Both subsequently sustained atypical femur fractures and underwent surgical stabilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Referred pain from a bisphosphonate-related femoral stress fracture can masquerade as pain about a total knee arthroplasty. This should be included in the differential diagnosis in at-risk patients because it can result in an atypical femoral shaft fracture above the prosthesis if not properly treated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.19.00160","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T07:16:56Z","timestamp":1582096616000},"page":"e0160-e0160","source":"Crossref","is-referenced-by-count":3,"title":["Impending Atypical Femur Fracture Presenting as Painful Total Knee Arthroplasty"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5358-9515","authenticated-orcid":false,"given":"Kyle A.","family":"Andrews","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-9690","authenticated-orcid":false,"given":"Emily I.","family":"Wynkoop","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2081-8868","authenticated-orcid":false,"given":"Phillip J.","family":"Stokey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Georgiadis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio"},{"name":"Department of Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020]]},"reference":[{"issue":"22","key":"bib1-20230720","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199511303332201","article-title":"Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group","volume":"333","author":"Liberman","year":"1995","journal-title":"N Engl J Med."},{"issue":"1","key":"bib2-20230720","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.1998","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research","volume":"29","author":"Shane","year":"2014","journal-title":"J Bone Miner Res.."},{"issue":"11","key":"bib3-20230720","doi-asserted-by":"crossref","first-page":"4483","DOI":"10.1210\/jc.2013-1597","article-title":"The effect of three or six years of denosumab exposure in women with postmenopausal osteoporosis: results from the FREEDOM extension","volume":"98","author":"Bone","year":"2013","journal-title":"J Clin Endocrinol Metab."},{"issue":"12","key":"bib4-20230720","doi-asserted-by":"crossref","first-page":"e939","DOI":"10.3928\/01477447-20111021-36","article-title":"Bisphosphonate fractures as a cause of painful total hip arthroplasty","volume":"34","author":"Curtin","year":"2011","journal-title":"Orthopedics."},{"issue":"3 suppl 1","key":"bib5-20230720","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1054\/arth.2003.50102","article-title":"Why knees fail","volume":"18","author":"Vince","year":"2003","journal-title":"J Arthroplasty"},{"issue":"2","key":"bib6-20230720","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ocl.2015.09.008","article-title":"The painful total knee arthroplasty","volume":"47","author":"McDowell","year":"2016","journal-title":"Orthop Clin North Am."},{"issue":"2","key":"bib7-20230720","doi-asserted-by":"crossref","first-page":"136","DOI":"10.11138\/ccmbm\/2017.14.1.136","article-title":"Histological study of atraumatic periprosthetic fractures: does atypical periprosthetic fracture exist?","volume":"14","author":"Bottai","year":"2017","journal-title":"Clin Cases Miner Bone Metab."},{"issue":"3","key":"bib8-20230720","doi-asserted-by":"crossref","first-page":"187","DOI":"10.5371\/hp.2015.27.3.187","article-title":"Periprosthetic atypical femoral fracture-like fracture after hip arthroplasty: a report of three cases","volume":"27","author":"Lee","year":"2015","journal-title":"Hip Pelvis."},{"key":"bib9-20230720","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s13256-015-0590-z","article-title":"Rare non-traumatic periprosthetic femoral fracture with features of an atypical femoral fracture: a case report","volume":"9","author":"Niikura","year":"2015","journal-title":"J Med Case Rep."},{"issue":"2","key":"bib10-20230720","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/1602400230","article-title":"Atypical periprosthetic femoral fracture: a case report","volume":"24","author":"Woo","year":"2016","journal-title":"J Orthop Surg (Hong Kong)."},{"issue":"5","key":"bib11-20230720","doi-asserted-by":"crossref","first-page":"622","DOI":"10.3109\/17453674.2015.1036339","article-title":"Bisphosphonate-associated peri-implant fractures: a new clinical entity? A series of 10 patients with 11 fractures","volume":"86","author":"Lee","year":"2015","journal-title":"Acta Orthop."},{"issue":"4","key":"bib12-20230720","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/BOT.0000000000000508","article-title":"Periprosthetic atypical femoral fractures in patients on long-term bisphosphonates: a multicenter retrospective review","volume":"30","author":"Robinson Jde","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib13-20230720","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11420-012-9275-y","article-title":"Management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures","volume":"8","author":"Saleh","year":"2012","journal-title":"HSS J."},{"issue":"4","key":"bib14-20230720","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s11914-018-0464-6","article-title":"Current understanding of epidemiology, pathophysiology, and management of atypical femur fractures","volume":"16","author":"Starr","year":"2018","journal-title":"Curr Osteoporos Rep."},{"issue":"7","key":"bib15-20230720","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1007\/s11999-011-1828-8","article-title":"Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures","volume":"469","author":"Banffy","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib16-20230720","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1056\/NEJMc1403799","article-title":"Risk of atypical femoral fracture during and after bisphosphonate use","volume":"371","author":"Schilcher","year":"2014","journal-title":"N Engl J Med."},{"issue":"11","key":"bib17-20230720","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1007\/s00198-017-4169-y","article-title":"Predisposing factors associated with atypical femur fracture among postmenopausal Korean women receiving bisphosphonate therapy: 8 years' experience in a single center","volume":"28","author":"Koh","year":"2017","journal-title":"Osteoporos Int."},{"issue":"4","key":"bib18-20230720","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/jbmr.2748","article-title":"Incidence and characteristics of atypical femoral fractures: clinical and geometrical data","volume":"31","author":"Mahjoub","year":"2016","journal-title":"J Bone Miner Res."},{"issue":"11","key":"bib19-20230720","doi-asserted-by":"crossref","first-page":"885","DOI":"10.3949\/ccjm.85a.17119","article-title":"Bisphosphonate-related atypical femoral fracture: managing a rare but serious complication","volume":"85","author":"Silverman","year":"2018","journal-title":"Cleve Clin J Med."},{"issue":"1","key":"bib20-20230720","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s12603-015-0652-3","article-title":"Epidemiology and postoperative outcomes of atypical femoral fractures in older adults: a systematic review","volume":"21","author":"Khow","year":"2017","journal-title":"J Nutr Health Aging."},{"issue":"12","key":"bib21-20230720","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1001\/archinternmed.2012.1796","article-title":"Increasing occurrence of atypical femoral fractures associated with bisphosphonate use","volume":"172","author":"Meier","year":"2012","journal-title":"Arch Intern Med."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.19.00160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:50Z","timestamp":1787751890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.19.00160"}},"subtitle":["A Report of 2 Cases"],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.19.00160","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}