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Femoral Revision Arthroplasty pp 99–112Cite as

Allograft Prosthesis Composite (APC) and Megaprostheses

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Abstract

In cases of pronounced defects of the proximal femur, it can be replaced by an allograft, as a so-called allograft prosthesis composite (APC), or by a prosthetic component acting as a proximal femoral replacement. The former technique (APC) is more likely to be considered in younger patients and the proximal femoral replacement in older patients. If it is no longer possible to anchor a prosthetic stem in the femur, an intramedullary (push-through prosthesis) or extramedullary total endoprosthetic femoral replacement is required. This chapter reviews the principles, surgical techniques, and outcomes reported in the literature.

Keywords

  • Allograft prosthesis composite
  • Megaprosthesis
  • Proximal femoral replacement
  • Total femoral replacement

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References

  1. Kellett CF, Boscainos PJ, Maury AC, et al. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2007;89-A(Suppl 2):S68–79.

    Google Scholar 

  2. Rasouli MR, Porat MD, Hozack WJ, Parvizi J. Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant bone loss. Orthop Surg. 2012;4:203–10.

    PubMed  PubMed Central  Google Scholar 

  3. Sakellariou VI, Babis GC. Management bone loss of the proximal femur in revision hip arthroplasty: update on reconstructive options. World J Orthop. 2014;5:614–22.

    PubMed  PubMed Central  Google Scholar 

  4. Lakstein D, Kosashvili Y, Backstein D, et al. Modified trochanteric slide for complex hip arthroplasty: clinical outcomes and complication rates. J Arthroplast. 2010;25:363.

    Google Scholar 

  5. Graham NM, Stockley I. The use of structural proximal femoral allografts in complex revision hip arthroplasty. J Bone Joint Surg. 2004;86:337–43.

    CAS  Google Scholar 

  6. Maury AC, Pressman A, Cayen B, et al. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am. 2006;88:953–8.

    PubMed  Google Scholar 

  7. Vastel L, Lemoine CT, Kerboull M, Courpied JP. Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function. Int Orthop. 2007;31:851–7.

    PubMed  PubMed Central  Google Scholar 

  8. Haddad FS, Spangehl MJ, Masri BA, et al. Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res. 2000;371:98–107.

    Google Scholar 

  9. Head WC, Berklacich FM, Malinin TI, Emerson HC Jr. Proximal femoral allografts in revision total hip arthroplasty. Clin Orthop Relat Res. 1987;225:22–36.

    Google Scholar 

  10. Head WC, Hillyard JM, Emerson RH, Peters PC Jr. Proximal femoral allografts in revision total hip arthroplasty. Semin Arthroplasty. 1993;4:92–8.

    CAS  PubMed  Google Scholar 

  11. Zmolek JC, Dorr LD. Revision total hip arthroplasty: the use of solid allograft. J Arthroplasty. 1993;8:361–70.

    CAS  PubMed  Google Scholar 

  12. Chandler H, Clark J, Murphy S, et al. Reconstruction of major segmental loss of the proximal femur in revision total hip arthroplasty. Clin Orthop Relat Res. 1994;298:67–74.

    Google Scholar 

  13. Gross AE, Hutchison CR, Alexeeff M, et al. Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. Clin Orthop Relat Res. 1995;319:151–8.

    Google Scholar 

  14. Blackley HR, Davis AM, Htichson CR, et al. Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up. J Bone Joint Surg Am. 2001;83-A:346–54.

    Google Scholar 

  15. Wang JW, Wang CJ. Proximal femoral allografts for bone deficiencies in revision hip arthroplasty: a medium-term follow-up study. J Arthroplasty. 2004;19:845–52.

    PubMed  Google Scholar 

  16. Safir O, Kellett CF, Flint M, Backstein D, Gross AE. Revision of the deficient proximal femur with a proximal femoral allograft. Clin Orthop Relat Res. 2009;467:206–12.

    PubMed  Google Scholar 

  17. Lee SH, Ahn YJ, Chung SJ, Kim BK, Hwang JH. The use of allograft prosthesis composite for extensive proximal bone deficiencies: a 2- to 9.8-year follow-up study. J Arthroplasty. 2009;24:1241–8.

    PubMed  Google Scholar 

  18. Babis GC, Sakellariou VI, O’Connor MI, et al. Proximal femoral allograft prosthesis composites in revision hip replacement: a 12 year follow-up study. J Bone Joint Surg Br. 2010;92-B:349–55.

    Google Scholar 

  19. Sternheim A, Rogers BA, Kuzyk PR, Safir OA, Backstein D, Gross AE. Segmental proximal femoral bone loss and revision total hip replacement in patients with developmental dysplasia of the hip. J Bone Joint Surg Br. 2012;94:762–7.

    CAS  PubMed  Google Scholar 

  20. Sternheim A, Drexler M, Kuzyk PR, Safir OA, Backstein DJ, Gross AE. Treatment of failed allograft prosthesis composites used for hip arthroplasty in the setting of severe proximal femoral bone defects. J Arthroplasty. 2014;29:1058–62.

    PubMed  Google Scholar 

  21. Parvizi J, Sim FH. Proximal femoral replacements with megaprostheses. Clin Orthop Relat Res. 2004;420:169–75.

    Google Scholar 

  22. Al-Taki MM, Masri BA, Duncan CP, et al. Quality of life following proximal femoral replacement using a modular system in revision THA. Clin Orthop Relat Res. 2011;469:470–5.

    PubMed  Google Scholar 

  23. Muhyeddine M, Al-Taki MD, Masri BA, Duncan CP, Garbuz DS. Quality of life following proximal femoral replacement using a modular system in revision THA. Clin Orthop Relat Res. 2011;469:470–5.

    Google Scholar 

  24. Sim FH, Chao EY. Hip salvage by proximal femoral replacement. J Bone Joint Surg Am. 1998;63-A:1228–32.

    Google Scholar 

  25. Malkani AL, Settecem JJ, Sim FH, et al. Long-term results of proximal femoral replacement for non-neoplastic disorders. J Bone Joint Surg Br. 1995;77-B:351–6.

    Google Scholar 

  26. Haentjens P, De Boeck H, Opdecam P. Proximal femoral replacement prosthesis for salvage of failed hip arthroplasty: complications in a 2–11 year follow-up study in 19 elderly patients. Acta Orthop Scand. 1996;67:37–42.

    CAS  PubMed  Google Scholar 

  27. Klein GR, Parvizi J, Rapuri V, Wolf CF, Hozack WJ, Sharkey PF, Purtill JJ. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005;87-A:1777–81.

    Google Scholar 

  28. Parvizi J, Tarity TD, Slenker N, et al. Proximal femoral replacement in patients with non-neoplastic conditions. J Bone Joint Surg Am. 2007;89-A:1036–43.

    Google Scholar 

  29. Shih ST, Wang JW, Hsu CC. Proximal femoral megaprosthesis for failed total hip arthroplasty. Chang Gung Med J. 2007;30:73–80.

    PubMed  Google Scholar 

  30. Schoenfeld AJ, Leeson MC, Vrabec GA, Scaglione J, Stonestreet MJ. Outcomes of modular proximal femoral replacement in treatment of complex proximal femoral fractures: a case series. Int J Surg. 2008;6:140–6.

    PubMed  Google Scholar 

  31. Bertani A, Helix M, Louis ML, et al. Total hip arthroplasty in severe segmental femoral bone loss situations: use of a reconstruction modular stem design (JVC IX). Retrospective study of 23 cases. Orthop Traumatol Surg Res. 2009;95:491.

    CAS  PubMed  Google Scholar 

  32. Gebert C, Wessling M, Götze C, et al. The modular universal tumour and revision system (MUTARS) in endoprosthetic revision surgery. Int Orthop. 2010;34:1261–5.

    PubMed  PubMed Central  Google Scholar 

  33. Sewell MD, Hanna SA, Carrington RW, et al. Modular proximal femoral replacement in salvage hip surgery for non-neoplastic conditions. Acta Orthop Belg. 2010;76:493.

    PubMed  Google Scholar 

  34. Dean BJF, Matthews JJ, Pric A, et al. Modular endoprosthetic replacement for failed internal fixation of proximal femur following trauma. Int Orthop. 2012;36:731.

    PubMed  Google Scholar 

  35. McLean AI, Patton JT, Moran M. Femoral replacement for salvage of periprosthetic fracture around a total hip replacement. Injury. 2012;43:1166–9.

    PubMed  Google Scholar 

  36. Colman M, Choi I, Chen A, et al. Proximal femoral replacement in the management of acute periprosthetic fractures of the hip: a competing risks survival analysis. J Arthroplasty. 2014;29:422.

    PubMed  Google Scholar 

  37. Lundh F, Sayed-Noor AS, Brosjö O, et al. Megaprosthetic reconstruction for periprosthetic of highly comminuted fractures of the hip and knee. Eur J Orthop Surg Traumatol. 2014;24:553.

    PubMed  Google Scholar 

  38. Korim MT, Esler CN, Ashford RU. Systematic review of proximal femoral arthroplasty for non-neoplastic conditions. J Arthroplasty. 2014;29:2117–21.

    PubMed  Google Scholar 

  39. Artiaco S, Boggop F, Colzani G, Titolo P, Zoccola K, Bainchi P, Bellomo F. Megaprostheses in the revision of infected total hip arthroplasty. Clinical series and literature review. Bul Hosp J Dis. 2015;73:229–32.

    Google Scholar 

  40. Grammatopulos G, Alvand A, Martin H, Whitwell D, Taylor A, Gibbons CL. Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Joint J. 2016;98-B:1463–70.

    Google Scholar 

  41. Curtin M, Bryan C, Murphy E, Murphy CG, Curtin W. Early results of the LPS limb preservation system in the management of periprosthetic femoral fractures. J Orthop. 2016;14:34–7.

    PubMed  PubMed Central  Google Scholar 

  42. Viste A, Perry KL, Taunton MJ, Hanssen AD, Abdel MP. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes. Bone Joint J. 2017;99-B:325–9.

    CAS  PubMed  Google Scholar 

  43. Hoell S, Butschek S, Gosheger G, Dedy N, Dieckmann R, Henrichs M, Daniilidis K, Hardes J. Intramedullary and total femur replacement in revision arthroplasty as a last limb-saving option: is there any benefit from the less invasive intramedullary replacement? J Bone Joint Surg Br. 2011;93-B:1545–9.

    Google Scholar 

  44. Amanatullah DF, Trousdale RT, Hanssen AD, Lewallen DG, Taunton MJ. Non-oncologic total femoral arthroplasty: retrospective review. J Arthroplasty. 2014;29:2013–5.

    PubMed  Google Scholar 

  45. Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Dodds KL. Total femoral arthroplasty for salvage of end-stage prosthesis disease. Clin Orthop Relat Res. 2004;2:162–70.

    Google Scholar 

  46. Fontain JR, Dalby-Bell J, Caroll FA, Stockley I. The use of total femoral arthroplasty as a limb salvage procedure: the Sheffield experience. J Arthroplasty. 2007;22:663–9.

    Google Scholar 

  47. Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am. 2005;87-A:2693–701.

    Google Scholar 

  48. Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty. 2006;21:107–11.

    PubMed  Google Scholar 

  49. Töpfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, Pförringer D, Töpfer M, Beier M, Crönlein M, von Eisenhart-Rothe R, Mühlhofer H. Short- to long-term follow-up of total femoral replacement in non-oncologic patients. BMC Musculoskelet Disord. 2016;17:498.

    Google Scholar 

  50. Peters CJ, Hickman JM, Erickson J, Lombardi AV, Berend KR, Mallory TH. Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty. J Arthroplasty. 2006;21:53–8.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Clinic Markgröningen, Markgröningen, Baden-Württemberg, Germany

    Bernd Fink

  2. Orthopaedic Department, University-Hospital Hamburg-Eppendorf, Hamburg, Germany

    Bernd Fink

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Fink, B. (2022). Allograft Prosthesis Composite (APC) and Megaprostheses. In: Femoral Revision Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-84821-7_9

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  • DOI: https://doi.org/10.1007/978-3-030-84821-7_9

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