Utilization of C-arm fluoroscopy during direct anterior total hip arthroplasty (THA) is disruptive and potentially increases the risks of patient infection and cumulative surgeon radiation exposure. This pilot study evaluated changes in surgeon C-arm utilization during an initial 10 cases of direct anterior THA in which an imageless computer-assisted navigation device was introduced. This retrospective study includes data from 20 direct anterior THA cases performed by two orthopaedic surgeons (BC; SRE) in which an imageless computer-assisted navigation device was utilized (Intellijoint HIP®; Intellijoint Surgical, Waterloo, ON, Canada). Total C-arm image count was recorded in each case, and cases were grouped in sets of 5 for each surgeon. The mean C-arm image count was calculated for each surgeon, and combined C-arm image counts were calculated for the study cohort. Student's t-tests were used to assess differences. The use of intraoperative C-arm fluoroscopy decreased from a mean of 9.4 images (standard deviation [SD]: 8.6; Range: 3 – 23) to a mean of 2 images (SD: 2.9; Range: 0 – 7) for surgeon BC (P=0.10) and decreased from a mean of 10.75 images (SD: 1.2; range 9 – 12) to a mean of 6.7 images (SD: 8.3; range: 0 – 16) for surgeon SRE (P=0.36). Combined, an overall decrease in intraoperative C-arm image count from a mean of 11.3 images (SD: 6.9; range: 6 – 23) to a mean of 3.7 images (SD: 3.9; range: 0 – 8.5) was observed in the study cohort (P=0.06). The adoption of imageless computer-assisted navigation in direct anterior THA may reduce the magnitude of intraoperative C-arm fluoroscopy utilization; however further analysis is required.

Periprosthetic fracture management after hip arthroplasty is complicated by poor bone stock and loose femoral components. Using a prospective database, thirty-five fractures treated by proximal femoral allograft reconstruction were identified. Patients treated between 1989–2000 with minimum two- year results, were reviewed at a mean of 3.8 years. Twenty-six fractures were acute, and nine had failed previous treatment. Union of the PFA was achieved in all but five cases (83%). In twenty-eight cases (78%) no further surgery was required and patient ambulation was pain free. When conventional treatment is not possible, the use of a PFA provides encouraging results.

Periprosthetic femoral fracture treatment is complicated by comminution, bone loss, and potentially loose femoral components. Treatment can include cast-braces, internal fixation, revision arthroplasty or the use of proximal femoral allograft composites (PFA). This study reports on thirty-five fractures treated with a PFA between 1989–2000. Five patients were lost and twelve patients (33%) were deceased. Follow-up averaged 3.8 years (range 0.1–11.3) with minimum two-year results in surviving patients. Six patients had either Rheumatoid arthritis or DDH with very narrow femoral canals.

There were twenty-three acute fractures, five failures of non-operative management, four failures of ORIF and two fractured femoral stems. Fractures were classified by the Vancouver system with: B1–7%, B2–30%, B3–43% and C-20%. Prefracture functional scores revealed that 30% of patients had significant functional impairment and were awaiting revision arthroplasty. Patients had had an average of two previous surgical procedures (range 1–4).

The mean length of the PFA was 14cm and union between graft and host bone was achieved in all but five cases (83%). Resorption of the graft was seen in eight cases (27%), lucent lines in six cases (20%) and implant migration in four cases (13%). Post revision arthroplasty Harris Hip and SF-36 scores revealed substantial disability in this patient group.

Twenty-eight cases (73%) were deemed successful with patients not requiring further surgery and enjoying pain free ambulation. In fractures with unstable femoral components and inadequate bone stock or very narrow femoral canals few options are available. This technique provides encouraging results and a viable option when conventional treatment is not possible.

Periprosthetic fracture management after hip arthroplasty is complicated by poor bone stock and loose femoral components. Using a prospective database, thirty-five fractures treated by proximal femoral allograft reconstruction were identified. Patients treated between 1989–2000 with minimum two- year results, were reviewed at a mean of 3.8 years. Twenty-six fractures were acute, and nine had failed previous treatment. Union of the PFA was achieved in all but five cases (83%). In twenty-eight cases (78%) no further surgery was required and patient ambulation was pain free. When conventional treatment is not possible, the use of a PFA provides encouraging results.

Periprosthetic femoral fracture treatment is complicated by comminution, bone loss, and potentially loose femoral components. Treatment can include cast-braces, internal fixation, revision arthroplasty or the use of proximal femoral allograft composites (PFA). This study reports on thirty-five fractures treated with a PFA between 1989–2000. Five patients were lost and twelve patients (33%) were deceased. Follow-up averaged 3.8 years (range 0.1–11.3) with minimum two-year results in surviving patients. Six patients had either Rheumatoid arthritis or DDH with very narrow femoral canals.

There were twenty-three acute fractures, five failures of non-operative management, four failures of ORIF and two fractured femoral stems. Fractures were classified by the Vancouver system with: B1–7%, B2–30%, B3–43% and C-20%. Prefracture functional scores revealed that 30% of patients had significant functional impairment and were awaiting revision arthroplasty. Patients had had an average of two previous surgical procedures (range 1–4).

The mean length of the PFA was 14cm and union between graft and host bone was achieved in all but five cases (83%). Resorption of the graft was seen in eight cases (27%), lucent lines in six cases (20%) and implant migration in four cases (13%). Post revision arthroplasty Harris Hip and SF-36 scores revealed substantial disability in this patient group.

Twenty-eight cases (73%) were deemed successful with patients not requiring further surgery and enjoying pain free ambulation. In fractures with unstable femoral components and inadequate bone stock or very narrow femoral canals few options are available. This technique provides encouraging results and a viable option when conventional treatment is not possible.