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

¹ Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, ON M5G 1X5, Canada. E-mail address for A.C. Maury: acjamaury{at}doctors.org

Investigation performed at Mount Sinai Hospital, Toronto, Ontario, Canada

NOTE: A.C. Maury would like to acknowledge the generous sponsorship of his clinical fellowship at Mount Sinai Hospital, Toronto, Ontario, Canada, by the John Charnley Trust, which facilitated completion of this study.

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the John Charnley Trust. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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, and osseous union of the allograft to the host femur occurred in twenty hips. 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.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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