Biomimetic Hematoma Enables Healing in Complex Periprosthetic Fracture Nonunion with Multiple Comorbidities

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.