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Biomimetic Hematoma Enables Healing in Complex Periprosthetic Fracture Nonunion with Multiple Comorbidities: A Case
Adam Maestas1, Vaida Glatt1,2, Joseph F Alderete1
1Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas.
Case:
An 80-year-old women with multiple comorbidities and a history of revision total knee arthroplasty presented with a periprosthetic tibial nonunion and severe varus deformity. She underwent dual-plate fixation with a biomimetic hematoma (BH) scaffold delivering recombinant human bone morphogenetic protein-2 (rhBMP-2) to manage oligotrophic nonunion. Radiographs confirmed complete union at 4 months. Following surgery and tirzepatide initiation, she progressed from wheelchair dependence to full weight bearing with walker assistance at 1 year, achieving a 75-pound weight loss.
Conclusion:
The BH delivering low-dose rhBMP-2 enabled successful bone healing and functional recovery in a medically complex patient, highlighting its potential in the treatment of challenging periprosthetic nonunions.
