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

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

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Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK

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

  2. Department of Orthopaedic Surgery, Fukushima Medical, University School of Medicine, Fukushima, 960-1295, Japan

    Yoichi Kaneuchi

  3. Aston University Medical School, Aston University, Birmingham, UK

    Jonathan D. Stevenson

Authors
  1. Danielle J. A. Maes
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  2. Yoichi Kaneuchi
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  3. Adesegun Abudu
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  4. Jonathan D. Stevenson
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Contributions

Jonathan Stevenson, Adesegun Abudu, Danielle Maes contributed to conceptualization; Jonathan Stevenson, Adesegun Abudu, Yoichi Kaneuchi, Danielle Maes were involved in methodology; Yoichi Kaneuchi, Danielle Maes contributed to formal analysis and investigation; Danielle Maes was involved in writing—original draft preparation; Yoichi Kaneuchi, Jonathan Stevenson, Adesegun Abudu contributed to writing—review and editing; Funding acquisition: [not applicable]; Resources: [not applicable]; Jonathan Stevenson, Adesegun Abudu were involved in supervision.

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Correspondence to Danielle J. A. Maes.

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Maes, D.J.A., Kaneuchi, Y., Abudu, A. et al. Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults. Eur J Orthop Surg Traumatol 32, 559–566 (2022). https://doi.org/10.1007/s00590-021-03015-y

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  • DOI: https://doi.org/10.1007/s00590-021-03015-y

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