Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Orthopaedics
Published in: International Orthopaedics 12/2018

01-12-2018 | Original Paper

Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft

Authors: Donghai Li, Qinsheng Hu, Pengde Kang, Jing Yang, Zongke Zhou, Bin Shen, Fuxing Pei

Published in: International Orthopaedics | Issue 12/2018

Login to get access

Abstract

Aims

This study was performed to evaluate the efficacy of reconstructing bone stock in Vancouver B3 periprosthetic femoral fractures (PFFs) using an impacted cancellous allograft cortical or combined with cortical strut allograft.

Patients and methods

We retrospectively assessed 39 Vancouver-type B3 periprosthetic fractures in 39 patients. Having different bone defects in the femur, 20 patients were treated with intramedullary impacted cancellous allograft, and 19 patients were treated with impacted cancellous allograft combined with cortical strut allograft. The median follow-up time was 58 months.

Results

Thirty-three patients completed the follow-up as scheduled, and three of them underwent re-operation (9.1%, 3/33). The last evaluated mean hip Harris score was 81.8; WOMAC pain, stiffness, and function scores were 82.3, 79.0, and 81.3, respectively. The satisfaction score was 86.6, and the SF-12 mental and physical scores were 40.4 and 51.1, respectively, for all patients. These outcomes were without significant difference between the two treatment groups (p > 0.05). The facture union was achieved in all the hips (100%). The stem was fixed with bone ingrowth in 24 patients and with fibrous fixation in eight, while stem fixation was not achieved for the remaining patient. The stem subsided less than 3 mm in 23 patients and 3–5 mm in nine patients. One patient had > 5 mm subsidence. The femoral bone stock was improved in 18 patients and remained unchanged in 14 patients; only one patient suffered a diminished bone stock. The radiographic assessment outcomes exhibited little difference between the two treatment groups (p > 0.05). Osseous union of the cortical strut to the host femur occurred in six patients with partial union and ten with complete union. There was moderate and mild graft resorption in three and 13 hips, respectively.

Conclusions

The use of impacted cancellous allograft and cortical strut allograft to reconstruct bone stock can provide reliable options and satisfactory results.
Literature
1.
Munro JT, Garbuz DS, Masri BA, Duncan CP (2014) Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res 472:590–598CrossRefPubMed
2.
Gillam MH, Ryan P, Graves SE, et al (2010) Competing risks survival analysis applied to data from the Australian Orthopaedic AssociationNational Joint Replacement Registry. Acta Orthop 81:548–555
3.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMed
4.
5.
Lindahl H, Malchau H, Herberts P et al (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplast 20:857–865CrossRef
6.
Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM (2008) Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 466:1652–1656CrossRefPubMedPubMedCentral
7.
Wu CC, Au MK, Wu SS, Lin LC (1999) Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc 98:190–194PubMed
8.
Singh JA, Jensen MR, Lewallen DG (2012) Patient factors predict periprosthetic fractures after revision total hip arthroplasty. J Arthroplast 27:1507–1512CrossRef
9.
Springer BD, Berry DJ, Lewallen DG (2003) Treatment of periprosthetic femoral fracture following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am 85:2156–2162CrossRefPubMed
10.
Lim CT, Amanatullah DF, Huddleston JI 3rd, Hwang KL, Maloney WJ, Goodman SB (2017) Cortical strut allograft support of modular femoral junctions during revision total hip arthroplasty. J Arthroplast 32:1586–1592CrossRef
11.
Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17
12.
Ten Have BL, Brouwer RW, van Biezen FC, Verhaar JA (2012) Femoral revision surgery with impaction bone grafting: 31 hips followed prospectively for ten to 15 years. J Bone Joint Surg (Br) 94:615–618CrossRef
13.
Sheth NP, Nelson CL, Paprosky WG (2013) Femoral bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21:601–612CrossRefPubMed
14.
Wu HB, Yan SG, Wu LD, He RX, Wang XH, Dai XS (2009) Combined use of extensively porous coated femoral components with onlay cortical strut allografts in revision of Vancouver B2 and B3 periprosthetic femoral fractures. Chin Med J 122:2612–2615PubMed
15.
Barden B, von Knoch M, Fitzek JG, Löer F (2003) Periprosthetic fractures with extensive bone loss treated with onlay strut allografts. Int Orthop 27:164–167PubMedPubMedCentral
16.
Pavlou G, Panteliadis P, Macdonald D, Timperley JA, Gie G, Bancroft G, Tsiridis E (2011) A review of 202 periprosthetic fractures—stem revision and allograft improves outcome for type B fractures. Hip Int 21:21–29CrossRefPubMed
17.
Kim YH, Park JW, Kim JS, Rastogi D (2015) High survivorship with cementless stems and cortical strut allografts for large femoral bone defects in revision THA. Clin Orthop Relat Res 473:2990–3000CrossRefPubMedPubMedCentral
18.
Mokka J, Keemu H, Koivisto M, Stormi T, Vahlberg T, Virolainen P, Junnila M, Seppänen M, Mäkelä KT (2013) Experience of structural onlay allografts for the treatment of bone deficiency in revision total hip arthroplasty. Scand J Surg 102:265–270CrossRefPubMed
19.
Safir O, Kellett CF, Flint M et al (2009) Revision of the deficient proximal femur with a proximal femoral allograft. Clin Orthop Relat Res 467:206–212CrossRefPubMed
20.
Barden B, Fitzek JG, Huttegger C et al (2001) Supportive strut grafts for diaphyseal bone defects in revision hip arthroplasty. Clin Orthop Relat Res 387:148CrossRef
21.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840
22.
Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRef
23.
Mahomed N, Gandhi R, Daltroy L, Katz JN (2011) The self-administered patient satisfaction scale for primary hip and knee arthroplasty. Arthritis 2011:591253
24.
Maury AC, Pressman A, Cayen B, Zalzal P, Backstein D, Gross A (2006) Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am 88:953–958CrossRefPubMed
25.
Engh Jr CA, McAuley JP, Engh Sr C (1999) Surgical approaches for revision total hip replacement surgery: the anterior trochanteric slide and the extended conventional osteotomy. Instr Course Lect 48:3
26.
Parvizi J, Tarity TD, Slenker N et al (2007) Proximal femoral replacement in patients with non-neoplastic conditions. J Bone Joint Surg Am 89:1036–1043CrossRefPubMed
27.
Al-Taki MM, Masri BA, Duncan CP, Garbuz DS (2011) Quality of life following proximal femoral replacement using a modular system in revision THA. Clin Orthop Relat Res 469:470–475CrossRefPubMed
28.
Gross AE, Allen G, Lavoie G (1993) Revision arthroplasty using allograft bone. Instr Course Lect 42:363–380PubMed
29.
Haddad FS, Garbuz DS, Masri BA, Duncan CP, Hutchison CR, Gross AE (2000) Femoral bone loss in patients managed with revision hip replacement: results of circumferential allograft replacement. Instr Course Lect 49:147–162PubMed
30.
Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res 371:98–107CrossRef
31.
Amenabar T, Rahman WA, Avhad VV, Vera R, Gross AE, Kuzyk PR (2015) Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty. Int Orthop 39:1927–1932CrossRefPubMed
Metadata
Title
Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft
Authors
Donghai Li
Qinsheng Hu
Pengde Kang
Jing Yang
Zongke Zhou
Bin Shen
Fuxing Pei
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 12/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-018-3997-5

Other articles of this Issue 12/2018

International Orthopaedics 12/2018 Go to the issue

Orthopaedic Heritage

Excellence in orthopaedic surgery: an overview of Nobel Prize nominees 1901–1960 with focus on Friedrich Pauwels and Gerhard Küntscher

Original Paper

Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones non-union

Original Paper

Coronal plane alignment of the lower limbs in patients with unilateral developmental hip dislocation

Original Paper

Accuracy of plain antero-posterior radiographic-based methods for measurement of acetabular cup version

Original Paper

Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: a systematic review and meta-analysis

Original Paper

Anatomical features and significance of the anterolateral ligament of the knee