Strut allografts for failed treatment of periprosthetic femoral fractures: Good outcome in 13 patients

Strut allografts are not recommended after a femoral shaft exposure, because they may endanger the femoral blood supply. Up till now, we have seen no clinical reports on this problem. We treated 13 consecutive patients with very large anteromedial and anterolateral femoral strut allografts to restabilize periprosthetic fractures which had become loose after a previous attempt at surgical fixation (Vancouver type B fractures with severe bone loss). In 8 cases, the stem was revised in conjunction with the use of strut allografts and in 5 cases, strut allografts alone were used. All refractures and nonunions healed without further treatment. At a mean follow-up of 3 (1.2-7) years, the mean Harris Hip Score was 78 (65-92). All strut grafts showed ingrowth with augmentation of periprosthetic bone on the radiographs. There were 3 complications, 1 nonprogressive subsidence of a revision stem (fibrous stable), 1 deep hematoma and 1 partial lesion of the sciatic nerve. In this series, strut grafts gave reliable healing with augmentation of the host bone stock despite previous femoral exposure, severe bone loss, adverse type of fracture, and persistent instability at the index operation.