Up to 10 years follow up of the use of 71 cortical allografts (strut-grafts) for the treatment of periprosthetic fractures

Abstract

Background and aims: Periprosthetic fractures are often located in areas of poor bone quality. There are multiple strategies to manage these fractures. Stable fixation in areas of low bone quality may require the use of cortical bone strut allografts.

Material and methods: Cortical allograft struts were used in the treatment of 71 patients with periprosthetic fractures between a 10 year period from 1/1999 until 12/2008. 18 patients had a periprosthetic fracture around the knee implant, 52 around the hip implant and 1 in between the hip and knee prosthesis. The average follow-up time was 943 days ranging from 90 days to 3428 days.

Results and conclusions: The overall union rate was 91%. 20 patients died during the follow-up, 6 of them during the first six month after operation. 8 patients (12%) had an diagnosed infection during the follow-up time. The specific strategy chosen to periprosthetic fracture treatment should depend on the quality of the remaining bone stock, type of the implant, location and classification of the fracture and on patients related factors, such age age and comorbidities. Use of cortical bone struts is a good option in fractures associated with poor bone quality. Use of allograft strut combined with a nonlocking plate, which offers the highest stiffness known, may provide superior bio-mechanical stability compared with other methods in some situations.