Teriparatide Treatment Improved Loosening of Cementless Total Knee Arthroplasty: A Case Report

INTRODUCTION: Along with the increase of osteoporotic patients in an aging society, complications in surgeries associated with osteoporosis are also increasing. In cementless total knee arthroplasty (TKA), poor primary stability and subsequent initial loosening of the implant may be seen. CASE REPORT: The patient, a 75-year-old Asian woman with a history of osteoporosis, underwent cementless TKA. Knee radiography at 5 weeks postoperatively showed radiolucent lines outlined beneath the tibial tray and around the stem. The tibial component was considered unstable due to loosening. A 56.5 µg weekly dose of teriparatide (rh [1-34] parathyroid hormone) was administered. After 2 months of treatment, knee pain and knee swelling had disappeared. Tomosynthesis taken after 6 months of treatment confirmed complete ingrowth of the component to the bone. CONCLUSION: This case showed that a weekly teriparatide administration of 56.5 µg improved initial loosening of the tibial implant in cementless TKA. Administration of teriparatide in cases of the osteoporotic patient who has loosening in cementless TKA may be a useful adjuvant to achieve bone ingrowth again.