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, and osseous union of the allograft to the host femur occurred in twenty
hips. There was mild graft resorption in four hips and moderate graft
resorption in two. Four (16%) of the twenty-five hips required repeat
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
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.