Treatment of Periprosthetic Femoral Shaft Nonunion

The purpose of this study is to review the contemporary treatment of periprosthetic femoral shaft nonunions. Thirteen periprosthetic femoral shaft nonunions in 13 patients were reviewed retrospectively. The average follow-up was 48.3 months. Five patients were treated with open reduction and internal fixation, 3 patients were treated with open reduction and internal fixation and prosthesis revision, and 5 were treated with partial femoral replacing prosthesis. Functional outcomes were assessed using a modified Harris hip score. Twelve of 13 nonunions were treated successfully as defined by either radiographic union or a well-functioning prosthesis. Four major complications, 2 requiring reoperation, were noted. These included persistent nonunion, dislocation, and new periprosthetic fracture. Successful treatment of periprosthetic femoral shaft nonunion yielded excellent pain relief, improved function, and patient satisfaction. However, complication and reoperation rates remain high.