Beyond the plate: is there a radiological advantage to cortical strut allografts in periprosthetic femoral fractures?

INTRODUCTION

Total hip arthroplasty (THA) is a major success in the management of osteoarthritis and is increasingly performed worldwide. As a result, complications related to hip prostheses-particularly periprosthetic femoral fractures (PPF)-are becoming more frequent, occurring in 4-5% of THA cases. These fractures often require surgical intervention. However, the optimal treatment strategy remains controversial, especially for Vancouver B1 and C fractures with stable implants. The literature lacks sufficient comparative studies evaluating the benefit of cortical strut allografts in this context.

METHODS

A retrospective, monocentric, comparative study was conducted including 41 patients with Vancouver B1 or C periprosthetic femoral fractures treated between 2016 and 2020. Patients were divided into two groups based on whether cortical strut allografts were used in addition to standard internal fixation. Clinical and radiographic outcomes were compared between groups.

RESULTS

Radiographic union was achieved more frequently in the group treated with adjunctive allografts. Mean mRUST at last follow-up was higher with allograft (14.75 ± 2.24) than without (12.25 ± 2.97), an absolute difference of 2.50 points (p = 0.007). The association of an allograft was not associated with an increase of complication or any infection rate.

DISCUSSION: The addition of cortical strut allografts appears to improve mechanical stability, reduce surgical failure, and enhance healing in Vancouver B1 and C fractures without increasing postoperative morbidity.