Femoral fractures in revision hip surgeries with impacted bone allograft

Impacted allograft bone in hip revision arthroplasty is a biologic reconstruction method that restores bone loss. Periprosthetic femoral fracture is one of the most frequent complications. However, the incidence, types of fracture, time of occurrence, predisposing factors, and whether and how complication affects the reconstruction are unknown. We analyzed 285 femoral revisions performed with this technique. Fractures occurred in 64 patients (22.4%). Fifty-nine of these 64 incidents (92%) occurred during surgery and five within the first postoperative year. Of the 59 intraoperative lesions, 34 were fractures (57.6%) and 25 were incidental perforations (42.3%). Most fractures and incidental perforations were associated with cement removal rather than the reconstructive technique. The reconstruction was compromised in two of the 34 fractures, but the remainder healed without complications. Five patients had a diaphyseal fracture develop within the first postoperative year, four of whom had an intraoperative incidental perforation. There was an increased risk of fractures within the first postoperative year in patients who had an incidental perforation during surgery and in those with severe bone defects. Despite the high rate of femoral complications associated with this reconstructive technique, most did not influence the reconstruction and only the intraoperative and postoperative complete diaphyseal fractures underwent additional treatment.