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Impaction femoral allografting and cemented revision for periprosthetic femoral fractures

The Whittington Hospital, Highgate Hill, London N19 5NF, UK.

F. S. Haddad, MCh (Orth), FRCS (Orth), Consultant Orthopaedic Surgeon

University College London Hospitals, Mortimer Street, London W1N 8AA, UK.

J. A. Timperley, FRCS (Ed), Consultant Orthopaedic Surgeon; and G. A. Gie, FRCS (Orth), Consultant Orthopaedic Surgeon

Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.

Correspondence should be sent to Mr G. A. Gie.

We reviewed retrospectively the outcome of the treatment by impaction grafting of periprosthetic femoral fractures around loose stems in 106 patients with Vancouver type-B2 and type-B3 fractures. Eighty-nine patients had a cemented revision with impaction grafting and a long or short stem. The remaining 17 had cemented revision without impaction grafting.

Fractures treated by impaction grafting and a long stem were more than five times likely to unite than those treated by impaction grafting and a short stem (odds ratio = 5.5, 95% confidence interval (CI) 1.54 to 19.6; p = 0.009). Furthermore, those with impaction grafting and a long stem were significantly more likely to unite than those with a long stem without impaction grafting (odds ratio = 4.07, 95% CI 1.10 to 15.0; p = 0.035).

There was also a trend towards a higher rate of union in those treated by impaction grafting than in those without (odds ratio = 2.69, 95% CI 0.86 to 8.45; p = 0.090).

Impaction grafting is being increasingly widely used for the restoration of femoral bone stock. It can be successfully applied to periprosthetic femoral fractures but a long stem should be used to bypass the distal fracture line.

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				K. O'Shea, J. F. Quinlan, S. Kutty, D. Mulcahy, and O. H. Brady The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures J Bone Joint Surg Br, December 1, 2005; 87-B(12): 1617 - 1621. [Abstract] [Full Text] [PDF]