Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey.
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.
Int Orthop. 2021 Jan;45(1):71-81. doi: 10.1007/s00264-020-04876-4. Epub 2020 Nov 18.
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.
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.
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.
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.
股骨周围与翻修或假体周围骨折（PFF）相关的骨缺损是一个问题。我们提出了一种在股骨翻修和/或 PFF 中使用腓骨自体移植物进行骨缺损重建的技术，并将我们的放射学和临床结果与同种异体移植物进行了比较。
共评估了 53 例接受髋关节翻修和/或 PFF 固定的患者，其中 20 例患者接受了皮质腓骨自体移植物（FG 组）或皮质同种异体移植物（CG 组）。排除后，对每组至少有 2 年随访的 20 例患者进行了放射学和临床结果的研究。
在 FG 和 CG 组中，中位年龄分别为 69.5（44-90）岁和 62（38-88）岁，随访时间分别为 59（28-72）个月和 120（48-216）个月，缺损长度分别为 7（1-10）cm 和 10（1-17）cm，移植物长度分别为 16.5（10-30）cm 和 20（12-37）cm。两组移植物的融合率均为 90%，融合时间分别为 7（4-12）个月和 12（6-24）个月（p<0.001），移植物吸收（中度和重度）率分别为 10%和 25%（p=0.41）。两组患者的 Harris Hip（77.6 分比 78.0 分）、WOMAC（23.2 分比 22.0 分）、SF-12 躯体（50.0 分比 46.1 分）和 SF-12 精神（53.8 分比 52.5 分）评分均相似。Kaplan-Meier 生存分析显示，FG 组的估计平均生存率为 6 年时为 100%，CG 组为 14 年时为 90%。
在股骨翻修或 PPF 后重建假体周围骨缺损时，腓骨骨皮质自体移植提供了与同种异体移植物相当的临床和放射学结果。其融合速度更快，具有成本效益，且易于获得，无明显发病率。
