Pasteurized autograft-prosthesis composite for proximal femoral reconstruction: An alternative to allograft composite

Background: Allograft-prosthesis composite (APC) for proximal femur reconstruction have shown favorable longevity and functional outcome compared to endoprosthesis, owing to restoration of bone stock, load-sharing property, and biological attachment of abductors and iliopsoas tendons. Questions/purposes: This study examined whether a pasteurized-prosthesis composite (PPC) is comparable to APC regarding implant survival, functional outcome, and complication rates. Patients and methods: We retrospectively reviewed 18 patients with proximal femur malignancy that underwent reconstruction with a cemented pasteurized autograft-prosthesis composite between 1993 and 2008. We evaluated implant survival (Kaplan-Meier), functional outcome (MSTS score), complications and secondary operations. Results: The estimated survival rate of the 18 composites was 86% at 5 and 10 years. Within a mean follow-up of 93 months (median 113, range 14-163) two composites (11%) were removed due to un-resolving infection. The mean MSTS functional score of surviving 16 composites was 80% (range 70-95). Non-union and stem loosening in host bone were identified in a single patient, while infection developed in two patients. THA conversion occurred in three composites due to secondary osteoarthritis in two, and subluxation in one case. Two of the six cases, with greater trochanter (GT) reconstruction, showed GT avulsion. No autograft was fractured. Conclusions: Pasteurized autograft-prosthesis composite (PPC) of the proximal femur has comparable survival rate, functional outcome, and complication rates to allograft-prosthesis composite (APC), thereby offering an alternative reconstructive option for proximal femoral reconstruction. © 2010 Springer-Verlag.