Proximal Femoral Allograft Treatment of Vancouver Type-B3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros.

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Presentation transcript:

Proximal Femoral Allograft Treatment of Vancouver Type-B3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros J. Boscainos, Anthony C. Maury, Ari Pressman, Barry Cayen, Paul Zalzal, David Backstein, and Allan Gross JBJS Essent Surg Tech Volume os-89(2 suppl 1):68-79 March 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A Vancouver type-B periprosthetic fracture of the femur. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A step-cut osteotomy. A step-cut osteotomy. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

An oblique osteotomy. An oblique osteotomy. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Reaming of the proximal femoral allograft is performed on a separate table. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The implant is cemented into the allograft and is now ready to be inserted into the host femur. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Note that the external rotators are left attached to the femur by leaving the posterior 1 cm of the greater trochanter attached to the femur. Note that the external rotators are left attached to the femur by leaving the posterior 1 cm of the greater trochanter attached to the femur. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The lateral cortex osteotomy of the proximal part of the femur. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The débrided host femur and the revised acetabular component. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Implant trial reduction. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A trial reduction of the implant only showing the limb-length-measuring device. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Trial reduction of the implant and allograft (not yet cemented). Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The allograft-prosthesis composite inserted into the host. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The implant is cemented into the proximal femoral allograft and is inserted into the host femur. The implant is cemented into the proximal femoral allograft and is inserted into the host femur. The graft-host junction is secured with cerclage wires. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The remnants of the proximal part of the host femur are fixed around the proximal femoral allograft with cerclage wires, particularly around the graft-host junction. The remnants of the proximal part of the host femur are fixed around the proximal femoral allograft with cerclage wires, particularly around the graft-host junction. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Reattachment of the greater trochanter. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Postoperative radiograph of a proximal femoral allograft used to treat the fracture depicted in Figure 1. Postoperative radiograph of a proximal femoral allograft used to treat the fracture depicted in Figure 1. Catherine F. Kellett et al. J Bone Joint Surg Am 2007;os-89:68-79 ©2007 by The Journal of Bone and Joint Surgery, Inc.