Complications of proximal femoral allografts in revision total hip arthroplasty.

Four revision hip arthroplasties using a well-described surgical construct involving a large frozen femoral allograft to replace a deficient proximal femur developed six major complications related to the use of the allograft or of the surgical construct. These cases represent three consecutive cases using this surgical construct performed by the senior author and one postoperative referral that used the same construct. The complications included three allograft fractures, two nonunions at the host-allograft junction, and one postoperative infection. All four of the patients previously had cemented revisions before the allograft procedure, and all had deficient proximal femurs at the time of the allograft procedure. All three of the fractures occurred at the tip of the femoral prosthesis within the allograft. The unacceptably high fracture rate, three of four, was associated with the allograft functioning as an unsupported load-bearing element in this study.