failed bipolar with protrusio

 A case send for opinion. elderly person with painful hip.  Pardon the poor qulaity pics

Problems.
osteoporosis with protrusio
well fixed stem
Anterior column penetration

Solutions
1. Hip has migrated superiomedially suggesting anterior coloumn penetration- Posterior column intact hence a primary cup is possible as good posterior bone is available. CT scans could delinate if needed.( superiorlateral migration suggests posterior column penetration)
2. Dislocating the hip  from posterior  will be easier as an anterior or anteriolateral approach will make dislocation difficult- my choice will be posterior approach. Gentle dislocation with a hook. If difficult do an ETO to remove the stem and cement and use any distal loading stem
3. Would treat the patients osteoporosis too- consider PTH. Any reports on strontium in the presence of uncemented THR.
4. Would anyone consider primary cemented THR is such osteoporotic bone as  I have seen quite a few bipolar migration is severe osteoporosis any comments