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Surgical Techniques   |    
Proximal Femoral Allograft Treatment of Vancouver Type-B3 Periprosthetic Femoral Fractures After Total Hip ArthroplastySurgical Technique
Catherine F. Kellett, BSc(Hons), BM, BCh, FRCS(Tr&Orth)1; Petros J. Boscainos, MD1; Anthony C. Maury, MSc, FRCS(Tr&Orth)1; Ari Pressman, MD, FRCSC1; Barry Cayen, MD1; Paul Zalzal, MD, FRCSC1; David Backstein, MD, FRCSC1; Allan Gross, MD, FRCSC, O.Ont.1
1 Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, ON M5G 1X5, Canada. E-mail address for A. Gross: allan.gross@utoronto.ca
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DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).
Investigation performed at Mount Sinai Hospital, Toronto, Ontario, Canada
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 953-958, May 2006

The Journal of Bone and Joint Surgery, Incorporated
JBJS Essential Surgical Techniques, 2007 Mar 01;89(2 suppl 1):68-79. doi: 10.2106/JBJS.F.01047
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Abstract

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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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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