Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, China.
J Orthop Surg (Hong Kong). 2022 Jan;30(1):10225536221095202. doi: 10.1177/10225536221095202.
Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone.
16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6 year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients.
The average follow-up was 46.3 months (range, 26-75 months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative ( < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative ( < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone.
Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.
股骨骨缺损是翻修近端股骨置换术的一个具有挑战性的问题。本研究旨在评估作为骨良性巨细胞瘤肿瘤切除术后严重骨丢失的保肢治疗，翻修近端股骨置换术的临床和影像学结果。
本回顾性研究纳入了 16 名患者（6 名男性和 10 名女性），翻修手术时的平均年龄为 46.6 岁。所有患者均采用模块化假体和皮质骨支撑同种异体骨进行翻修近端股骨置换术。采用改良 Harris 髋关节评分、SF-36 量表和肌肉骨骼肿瘤学会评分对患者进行评估。定期随访评估患者的复发和转移率、肢体功能和长期并发症。
平均随访 46.3 个月（范围 26-75 个月），患者无局部复发和转移。在末次随访时，平均改良 Harris 髋关节评分为 70.6 分，与术前相比明显改善（ < 0.05）。SF-36 量表、肌肉骨骼肿瘤学会评分和肢体长度差异的最终随访结果也明显优于术前（ < 0.05）。在末次随访时，植入的股骨柄均稳定，所有皮质骨支撑同种异体骨均与自身骨融合。
对于骨良性巨细胞瘤切除术后严重股骨近端骨丢失的相对年轻患者，使用模块化假体和皮质骨支撑同种异体骨进行翻修近端股骨置换术是一种可接受的方法。在这些复杂的重建中，应更加注意降低并发症的风险。
