Abstract
Introduction: There are approximately 50000 hip and knee arthroplasties performed in the UK every year. With this increasing number the prevalence of periprosthetic fractures is also rising. These are often challenging problems with increased morbidity and mortality. The use of cortical strut allografts in periprosthetic fractures was first reported in the early 90’s with favourable results.The aim of this study was to assess the radiological outcome of cortical strut allografts used as the treatment for periprosthetic fractures of the femur in patients presenting to our institution.
Patients & Methods: 17 patients with who had received strut allografts as part of their treatment for a periprosthetic fracture of the femur were identified. 13 fractures were around a total hip replacement and 4 around other femoral implants (2 long stemmed TKR’s and 2 fracture fixation devices).
We undertook a radiological evaluation of this technique. We assessed fracture union and strut allograft incorporation using the radiological criteria of Emerson et al. The procedure was deemed a success if the fracture had united, with evidence of graft incorporation with a stable implant. We also undertook a notes review identifying any risk factors and any previous surgery.
Results: Two patients died in the early post-operative period. 15 patients were available for analysis. The average length of radiographic review was 16 months. 11/15 procedures (73%) were deemed a success. All these showed evidence of graft incorporation which was time dependent. There were four failures. In one patient the struts fractured at two months. There were three cases of deep sepsis, this required amputation in one and excision arthroplasty in two.
Conclusion: Cortical strut allografts are a good technique for the management of periprosthetic fractures of the femur. As well as providing initial support they also become incorporated which improves the host bone stock.
Theses abstracts were prepared by Mr Peter Kay. Correspondence should be address to him at The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.
