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

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Clinical Orthopaedics and Related Research®

Abstract

Proximal femur allograft-prosthesis composites (APCs) performed with compression plates and a short stem theoretically could minimize the resorption or nonunion that reportedly occurs with long stems bypassing the diaphyseal osteotomy. To confirm this theoretical consideration, we retrospectively reviewed 34 patients with 38 proximal femoral APCs using a short-cemented femoral stem and compression plates for diaphyseal osteotomy fixation. In 26 patients, the plate fixation extended over at least half the femoral stem and in 12, it did not. We reinserted the abductor mechanism with two techniques: in 10 cases the host trochanter was reattached to the APC, and in 28 the host tendons were sutured to the tendinous insertion of the allograft. The overall survival of the entire series was 72% at 5 years and 69% at 10 years. Eleven of the 38 (29%) APCs were removed: three for infection, one for local recurrence of tumor, and seven for fractures. Trendelenburg gait occurred in four of 21 patients with direct tendon-to-tendon suture of the abductor mechanism and in three of six patients with trochanteric osteotomy. The overall APC survival rate was greater in patients in whom the allograft was adequately protected with internal fixation than in patients in whom it was not.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Institute of Orthopedics, “Carlos E. Ottolenghi” Italian Hospital of Buenos Aires, Potosí 4215 (1199), Buenos Aires, Argentina

    D. Luis Muscolo MD, German L. Farfalli MD, Luis A. Aponte-Tinao MD & Miguel A. Ayerza MD

Authors
  1. D. Luis Muscolo MD
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  2. German L. Farfalli MD
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  3. Luis A. Aponte-Tinao MD
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  4. Miguel A. Ayerza MD
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Correspondence to D. Luis Muscolo MD.

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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.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Muscolo, D.L., Farfalli, G.L., Aponte-Tinao, L.A. et al. Proximal Femur Allograft-prosthesis with Compression Plates and a Short Stem. Clin Orthop Relat Res 468, 224–230 (2010). https://doi.org/10.1007/s11999-009-0903-x

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  • DOI: https://doi.org/10.1007/s11999-009-0903-x

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