title: Freeze Dried Proximal Femoral Allografts in Revision of Femoral Stems.
abstract: Femoral bone deficiency is a challenging problem in revision femoral arthroplasty in younger patients. We evaluated outcomes of revision femoral arthroplasty using a freeze-dried allograft prosthetic composite (APC).
  
  
  
  This was a retrospective review of 16 patients (12 men and 4 women) who had unilateral proximal femoral deficiencies (Paprosky type III B, 13 patients; type IV, 3 patients) revised with freeze-dried APC. Follow-up at mean 7 years included assessment with Merle D'Aubigné score and radiographs.
  
  
  
  At follow-up, the average hip score was improved for pain, function, and range of motion. The 5-year graft survival was 87%, and the estimated median survival was 8.8 years. There were 3 patients who walked without support, 10 patients who walked unlimited distance with a cane, 2 patients who walked with 2 crutches, and 1 patient who walked with a walker. Radiographs showed nonunion at the graft-host junction in 3 hips (19%), but only 1 patient was symptomatic. Asymptomatic trochanteric nonunion was observed in 4 hips (25%). There was moderate graft resorption in 2 patients at 9 years after surgery and mild graft resorption in 1 graft at 7 years. There was subsidence of <2 cm in 2 patients and 3.5 cm in 1 patient.
  
  
  
  The present study showed acceptable results in treatment of major femoral deficiencies using freeze-dried APC in younger patients. Freeze-dried APC may be a useful for revision femoral arthroplasty.
authors.affiliation: Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Associate Professor at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.
authors.forename: Imran
authors.initials: I
authors.lastname: Ilyas
authors.affiliation: Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Husam
authors.initials: H
authors.lastname: Alrumaih
authors.affiliation: Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Samar
authors.initials: S
authors.lastname: Rabbani
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D005612:Freeze Drying; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: allograft prosthetic composite (APC); bone bank; bone graft; femoral bone loss; revision hip arthroplasty