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Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur

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Abstract

Background

Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft.

Methods

A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes.

Results

In FG and CG groups, the median ages were 69.5(44–90) and 62(38–88) years, follow-ups were 59(28–72) and 120(48–216) months, defect lengths were seven (1–10) and ten (1–17) cm, and grafts lengths were 16.5(10–30) and 20(12–37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4–12) and 12(6–24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan–Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group.

Conclusion

In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey

    İbrahim Tuncay, Orkhan Aliyev, Gökçer Uzer & Fatih Yıldız

  2. Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey

    Remzi Tözün, Göksel Dikmen & Vahit Emre Özden

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  1. İbrahim Tuncay
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  2. Remzi Tözün
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  3. Orkhan Aliyev
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Correspondence to Fatih Yıldız.

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The authors declare that they have no conflict of interest.

Ethical review committee statement

This retrospective study was approved by the institutional review board (45446446-010.99-5866).

A statement of the location where the work was performed

Patients who were reconstructed with fibular autograft were applied in Bezmialem Vakif University Hospital, and patients who were reconstructed with cortical allograft were applied in Acibadem Maslak Hospital.

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Tuncay, İ., Tözün, R., Aliyev, O. et al. Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur. International Orthopaedics (SICOT) 45, 71–81 (2021). https://doi.org/10.1007/s00264-020-04876-4

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