Revision of the Deficient Proximal Femur With a Proximal Femoral Allograft

Abstract

Substantial bone loss is frequently encountered with revision hip arthroplasty. A proximal femoral allograft may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 5 cm. We retrospectively reviewed 92 patients (93 hips) who underwent such proximal femoral allografts. The average age at the surgery was 61 years. The average number of previous revision procedures was 2.5. Six patients were lost to followup. Thirty-four of 36 deceased patients had the original proximal femoral allograft at the time of death. The minimum followup for the 50 remaining patients was 15 years (average, 16.2 years; range, 15-22 years).

Proximal Femur Allograft-prosthesis with Compression Plates and a Short Stem

“…Most of these occurred in the group of patients with short internal fixation (six of the seven cases). This complication occurred more frequently than with other series with APC that used long stems [3,7,18,23,25]. We now attempt to minimize this complication using a long plate.…”

“…Reconstruction options for these patients include endoprosthetic replacement or composite reconstruction using allografts and prostheses [2,3,4,7,8,13,16,18,23,25]. An osteochondral allograft rarely is indicated for reconstructing the proximal femur [14].…”

“…An osteochondral allograft rarely is indicated for reconstructing the proximal femur [14]. APCs have been used to reconstruct defects from wide tumor excisions since the late 1980s [3,7,8,15,18,23,25]. Advantages of proximal femur APC over endoprosthetic replacement include its ability to support mechanical loads and increased potential for reattaching tendons of the hip.…”

“…Advantages of proximal femur APC over endoprosthetic replacement include its ability to support mechanical loads and increased potential for reattaching tendons of the hip. Use of the APC also eliminates the need for articular congruence [3,7,8,18,23,25]. One additional purported advantage of allografts over synthetic materials is the former may be incorporated progressively by the host [19,21,22].…”

“…Several methods for proximal femoral APC have been described, and most include using a long stem bypassing the diaphyseal osteotomy [3,7,18,23]. Long stems potentially reduce the risk of femoral allograft fractures, but these kinds of femoral prostheses transfer loads through Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”