Uncemented allograft-prosthetic composite reconstruction of the proximal femur

Abstract

Background:Allograft–prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft–prosthetic composites, but have rarely focused on the uncemented allograft–prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft–prosthetic composite and to present the radiographic and clinical results.Materials and Methods:Twelve patients who underwent uncemented allograft–prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated.Results:In our series, union occurred in all the patients (100%; range 5-9 months). Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were 26.2 points (range 24-29 points) and 80.6 points (range 66.2-92.7 points), respectively.Conclusions:These results showed that uncemented allograft–prosthetic composite could promote bone union through compression at the host–allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

Management of periprosthetic femoral fractures following total hip arthroplasty: a review

“…APCs can be performed utilizing a cemented, an uncemented, or a partially cemented technique [54]. This procedure is technically demanding and has a high complication rate, including allograft nonunion, graft resorption, and disease transmission [57].…”

“…extensively porous-coated stems, TMFT stems, and cemented stems). However, for Vancouver B 3 fractures, other treatment modalities are important to consider such as impaction bone grafting [50][51][52], resection arthroplasty [53], allograft prosthetic composites (APCs) [53,54], and proximal femoral replacements.…”

Uncemented Arthroplasty After Hip Metastatic Disease and Multiple Myeloma

“…To date, cemented components are the traditional surgical technique when a hip arthroplasty is indicated for pain or fracture after metastatic disease or multiple myeloma in the hip area. 3 , 11 - 13 Previous studies have described the use of composite allograft with uncemented arthroplasty in the treatment of primary bone tumors, 14 arguing that the cardiovascular risks associated with the use of cement could be avoided. This is also a strong argument in relation to patients with metastatic disease and multiple myeloma, as their overall health status is frequently compromised.…”

Periprosthetic hip fractures: an update into their management and clinical outcomes

“…Allograft prosthetic composites can be used with either uncemented, cemented or partially cemented techniques. 92 , 93 They can be a valuable option in the presence of massive bone loss, especially in young patients. 90 , 94 …”