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

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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.

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Acknowledgments

This study was supported by  the Project of International Cooperation of Sichuan Province of China (2016HH0071).

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Author notes

  1. Donghai Li and Qinsheng Hu contributed equally to this work and should be regarded as first co-authors.

Authors and Affiliations

  1. Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan, 610041, People’s Republic of China

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

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  1. Donghai Li
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Correspondence to Pengde Kang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical review committee statement

The study was approved by the Clinical Trials and Biomedical Ethics Committee of West China Hospital, and written informed consents were obtained from all participants.

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Li, D., Hu, Q., Kang, P. et al. Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. International Orthopaedics (SICOT) 42, 2787–2795 (2018). https://doi.org/10.1007/s00264-018-3997-5

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  • DOI: https://doi.org/10.1007/s00264-018-3997-5

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