Eur J Orthop Surg Traumatol. 2021 May 28; doi: 10.1007/s00590-021-03015-y. Epub 2021 May 28.

Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults.

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Danielle J A Maes, Yoichi Kaneuchi, Adesegun Abudu, Jonathan D Stevenson

PMID: 34047855 DOI: 10.1007/s00590-021-03015-y

Abstract

PURPOSE: Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG).

METHODS: Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups.

RESULTS: The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups.

CONCLUSION: The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.

Keywords: Autografts; Bone transplantation; Femur; Fibula; Neoplasms

References

1. De Mattos CBR, Binitie O, Dormans JP (2012) Pathological fractures in children. Bone Joint Res 1:272–280. https://doi.org/10.1302/2046-3758.110.2000120 - PubMed
2. Jaffe KA, Dunham WK (1990) Treatment of benign lesions of the femoral head and neck. Clin Orthop Relat Res 257:134–137 - PubMed
3. Shih HN, Cheng CY, Chen YJ, Huang TJ, Hsu RWW (1996) Treatment of the femoral neck and trochanteric benign lesions. Clin Orthop Relat Res 328:220–226 - PubMed
4. George B, Abudu A, Grimer RJ, Carter SR, Tillman RM (2008) The treatment of benign lesions of the proximal femur with non-vascularised autologous fibular strut grafts. J Bone Joint Surg Br. https://doi.org/10.1302/0301-620X.90B5.20330 - PubMed
5. Rafalla A, Elsheikh M (2013) Use of an autologous nonvascularized fibular strut graft in the treatment of benign cystic lesions of the proximal femur. Egypt Orthop J 49:220–224. https://doi.org/10.4103/1110-1148.148191 - PubMed
6. Rahman MA, El Masry AM, Azmy SI (2018) Review of 16 cases of aneurysmal bone cyst in the proximal femur treated by extended curettage and cryosurgery with reconstruction using autogenous nonvascularized fibula graft. J Orthop Surg (Hong Kong) 26:1–6. https://doi.org/10.1177/2309499018783905 - PubMed
7. Kumar V, Sudesh P, Mootha AK, Dhillon M, Patil S (2011) Proximal femoral reconstruction using angle blade plate in aggressive lesions of proximal femur in children: treatment of three cases and review of literature. Eur J Orthop Surg Traumatol 21:127–130. https://doi.org/10.1007/s00590-010-0669-6 - PubMed
8. Erol B, Topkar MA, Aydemir AN, Okay E, Calliskan E, Sofulu O (2016) A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-016-2486-9 - PubMed
9. Khalifa YE, El-Kady HA, Abdel-Aal AM, Khalil AM (2010) Pathologic proximal femoral fracture complicating aneurysmal bone cyst: management and alternatives of fixation in eight patients. Current Orthopaedic Practice 21(4):390–395 - PubMed
10. Wai EK, Davis AM, Griffin A, Bell RS, Wunder JS (2001) Pathologic fractures of the proximal femur secondary to benign bone tumors. Clin Orthop Rel Res 393:279–286 - PubMed
11. Jaffe KA, Launer EP, Scholl BM (2002) Use of a fibular allograft strut in the treatment of benign lesions of the proximal femur. Am J Orthop 31:575–578 - PubMed
12. Majoor BCJ, Peeters-Boef MJM, van de Sande MAJ, Appelman-Dijkstra NM, Hamdy NAT, Dijkstra PDS (2017) What is the role of allogeneic cortical strut grafts in the treatment of fibrous dysplasia of the proximal femur? Clin Orthop Relat Res 475:786–795 - PubMed
13. Tomaszewski R, Rutz E, Mayr J, Dajka J (2020) Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03687-x - PubMed
14. Zhang Y, Li J, Lu X, Zhang Y, Zhang H, Shi H, Lei Z, Feng G, Fu W (2017) Intramedullary nailing combined with bone grafting for benign lesions of the proximal femur. Orthopaedic 9:97–102. https://doi.org/10.1111/os.12311 - PubMed
15. Nakamura T, Matsumine A, Asanuma K, Matsubara T, Sudo A (2015) Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft. SICOT-J 1:15. https://doi.org/10.1051/sicotj/2015009 - PubMed
16. Zekry KM, Yamamoto N, Hayashi K et al (2018) Treatment of the benign lytic lesions of the proximal femur with synthetic bone graft. J Orthop Surg Res 13:270. https://doi.org/10.1186/s13018-018-0982-z - PubMed
17. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard D (1991) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246 - PubMed
18. Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Joint Surg 84:454–464 - PubMed
19. Kucera T, Urban K, Ragkou S (2011) Healing of cavitary bone defects. Eur J Orthop Surg Traumatol 22:123–128. https://doi.org/10.1007/s00590-011-0831-9 - PubMed

Publication Types

• Journal Article