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Femoral Revision With Allograft Prosthetic Composite
An allograft prosthetic composite (APC) is indicated for patients in whom massive circumferential segmental proximal femoral bone loss precludes reconstruction with a more conventional proximally or distally fixed revision femoral stem. Proximal femoral bone loss can result from several causes, including osteolysis, periprosthetic fracture, and infection, usually in association with multiple prior total hip arthroplasty and revision procedures. The allograft is a circumferential structural replacement of the proximal femur. A long-stem femoral implant extends through the allograft and into the distal femoral host bone. Although revascularization of a cortical allograft is unlikely, the reconstruction provides sites for muscle attachment, may improve bone stock, and reduces femoral implant stresses. Successful restoration of hip function has been reported in approximately 70% to 90% of hips at 4- to 16-year follow-up after APC reconstruction. However, complications such as deep infection, host-allograft nonunion, allograft resorption, loosening, instability, and trochanteric nonunion also have been observed in most studies. Trochanteric nonunion has been reported in greater than 50% of hips. Although favorable long-term successful salvage of hip function can be expected after APC reconstruction, patients are at substantial risk for complications requiring re-revision surgery. This chapter reviews the indications, contraindications, and surgical techniques for the use of a APC in femoral revision. Postoperative protocols and tips for avoiding pitfalls and complications are also discussed.