JBJS, October 1, 2007, Volume 89, Issue suppl_3

Proximal Femoral Allograft Treatment of Vancouver Type-B3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty

Catherine F. Kellett, BSc(Hons), BM, BCh, FRCS(Tr&Orth) Petros J. Boscainos, MD Anthony C. Maury, MSc, FRCS(Tr&Orth) Ari Pressman, MD, FRCSC Barry Cayen, MD Paul Zalzal, MD, FRCSC David Backstein, MD, FRCSC Allan Gross, MD, FRCSC, O.Ont.

Hip

BACKGROUND:

Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. When a fracture occurs in a femur with substantial proximal bone deficiency, the surgical options for revision are limited. One option includes the use of a proximal femoral allograft.

METHODS:

We retrospectively assessed the results and complications of the use of a proximal femoral allograft to treat twenty-five Vancouver type-B3 periprosthetic fractures in twenty-four patients. The mean duration of follow-up was 5.1 years. Clinical results were graded with use of the Harris hip score. Radiographs were assessed for evidence of trochanteric union, host-allograft union, allograft resorption, and component loosening or fracture. Failure of the procedure was defined as the need for revision surgery requiring graft removal.

RESULTS:

The mean postoperative Harris hip score was 70.8. At the time of the final follow-up, twenty-one of the twenty-four patients reported no or mild pain and twenty-three patients were able to walk; fifteen required a walking aid. The greater trochanter united in seventeen of the twenty-five hips (68%), and osseous union of the allograft to the host femur occurred in twenty hips (80%). There was mild graft resorption in four hips and moderate graft resorption in two. Four (16%) of the twenty-five hips required repeat revision.

CONCLUSIONS:

The use of a proximal femoral allograft for the treatment of a Vancouver type-B3 periprosthetic femoral fracture can provide a satisfactory result in terms of pain relief and function at five years.

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