We reviewed a consecutive series of 19 patients with comminuted periprosthetic fractures, loosening of the femoral stem (Vancouver type B3) and significant loss of bone stock (Paprosky type III and IV). Sixteen porous-coated long stems and three Exeter stems, all with impaction grafting, were used. Large femoral onlay strut allografts were applied to maintain fracture reduction and improve stability. There was one early refracture at the tip of the femoral stem. Eighteen fractures healed without deformity and shortening. At the last follow-up at mean 3.7 (2.0-7.5) years, the mean Harris hip score was 76.4 (57.5-92.0). There was ingrowth of all strut grafts and significant augmentation of periprosthetic bone.Résumé Nous avons examiné une série consécutive de 19 malades présentants une fracture comminutive périprothétique, un descellement de la tige fémorale (type Vancouver B3) et une perte du stock de osseux (type Paprosky III et IV). Seize longues tiges à revêtement poreux et trois tiges Exeter, toutes avec greffes impactées ont été utilisé. Des baguettes d'allogreffes ont été appliqués pour maintenir la réduction de la fracture et améliorer la stabilité. Il y avait, précocement, une re-fracture à la pointe de la tige fémorale. Dix-huit fractures ont guéri sans déformation ni raccourcissement. Au dernier suivi, en moyenne 3.7 (2.0-7.5) années le score moyen de Harris était 76.4 (57.5-92.0). Il y avait incorporation de toutes les greffes et augmentation notable de l'os périprothétique.
Failure of the femoral component due to severe loss of femoral bone is an important long-term complication of total hip arthroplasty. We treated four patients with a type IV femoral defect (Paprosky classification) because of aseptic and septic loosening. To enhance bone stock and create a stable prosthetic reconstruction we used femoral allografts as inlay strut grafts alone or combined with onlay strut grafts and impaction grafting. At a mean follow-up of 11 years all four patients presented good or excellent results with Harris Hip Score between 86 and 95 points. Radiologically, no migration of the stems were found and the struts showed signs of incorporation. Inlay strut grafts are a reliable method for bone reconstruction of deficient femoral bone stock in failed total hip replacement.
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