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.
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.
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
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.