Femoral Fractures in Revision Hip Surgeries with Impacted Bone Allograft

Abstract

Impacted allograft bone in hip revision arthroplasty is a biologic reconstruction method that restores bone loss. Periprosthetic femoral fracture is one of the most frequent complications. However, the incidence, types of fracture, time of occurrence, predisposing factors, and whether and how complication affects the reconstruction are unknown. We analyzed 285 femoral revisions performed with this technique. Fractures occurred in 64 patients (22.4%). Fifty-nine of these 64 incidents (92%) occurred during surgery and five within the first postoperative year. Of the 59 intraoperative lesions, 34 were fractures (57.6%) and 25 were incidental perforations (42.3%). Most fractures and incidental perforations were associated with cement removal rather than the reconstructive technique. The reconstruction was compromised in two of the 34 fractures, but the remainder healed without complications. Five patients had a diaphyseal fracture develop within the first postoperative year, four of whom had an intraoperative incidental perforation. There was an increased risk of fractures within the first postoperative year in patients who had an incidental perforation during surgery and in those with severe bone defects. Despite the high rate of femoral complications associated with this reconstructive technique, most did not influence the reconstruction and only the intraoperative and postoperative complete diaphyseal fractures underwent additional treatment.

Risk Factors for Revision of Hip Arthroplasties in Patients Younger Than 30 Years

“…In contrast, types of complications were different from those after revision in older patients. The fracture rate (14%) in our patients was lower than the rate after THA revision in older patients (16% reported by Park et al [27], 22% reported by Farfalli et al [14], and 30% reported by Meek et al [22]). The dislocation rate (15%) for our patients was higher than usually observed after revision THAs (5% reported by Park et al [27], 8% reported by Kinkel et al [20], and 9% reported by Ornstein et al [26]).…”

Prevalence and risk factors for intra-operative periprosthetic fractures in one thousand eight hundred and seventy two patients undergoing total hip arthroplasty: a cross-sectional study

“…However, the strengths of our study must also be highlighted: the evaluation of intra-operative fractures in a large sample, and among patients with cemented prostheses and revision surgeries with impacted bone graft, which knowingly is a risk factor for periprosthetic fractures, especially when a short implant is used [22][23][24].…”

Bacterial Colonization of Bone Allografts: Establishment and Effects of Antibiotics

“…Additionally, once antibiotic is depleted, the graft is again susceptible to bacterial colonization. Therefore, although use of allograft has yielded excellent results, its use in cases of infection has been controversial as a result of the possible increased risk of reinfection [8,9,18].…”