PMC6581984_01
Preoperative anteroposterior radiograph of the pelvis showing bilateral Vancouver type-B2 periprosthetic femoral fracture.
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The bone lesions were classified as Vancouver type-B2 periprosthetic femoral fracture (Fig. 1).
Preoperative anteroposterior radiographs of the hips showing bilateral isoelastic prosthesis with osteolysis along the whole length of the femoral stem after 24 and 21 years in situ. Broken screws due to the prosthetic instability.
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On both sides it was possible to observe a biological process of acetabular polyethylene wear, instability of the femoral stem with broken femoral screws, and Paprosky type II femoral osteolysis (Fig. 2).
The femoral component of the third-generation isoelastic RM  total hip replacement is easily perforated with a 3.2 mm drill due to their polymeric composition.
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The femoral stem was easily perforated with a 3.2 mm drill because the implant is composed by a polymer (Fig. 3), a polyacetal resin, with a stainless steel core to avoid over-elasticity in the neck region.
Postoperative radiograph images of the pelvis and of bilateral femur after open reduction and ORIF with locking compression plates. At follow-up period of 12 months, the X-rays showed bone union of both fractures and bilateral stable stem fixation. The lateral radiograph of the right femur showed also no signs of bone resorption of the fibular allograft.
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The femoral radiograph showed consolidation of both fractures and the fibular structural allograft had no signs of bone resorption (Fig. 4).