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Proximal Femoral Allograft Treatment of Vancouver Type-B 3 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.

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Page 1: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

Proximal Femoral Allograft Treatment of Vancouver Type-B

3 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 TechVolume os-89(2 suppl 1):68-79

March 1, 2007

©2007 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 3: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 4: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 5: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 6: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 7: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 8: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 9: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 10: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 11: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 12: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 13: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 14: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

The implant is cemented into the proximal femoral allograft and is 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.

Page 15: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 16: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.

Page 17: Proximal Femoral Allograft Treatment of Vancouver Type- B 3 Periprosthetic Femoral Fractures After Total Hip Arthroplasty by Catherine F. Kellett, Petros

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.