Leibold Christiane Sylvia, Hecker Andreas, Schmaranzer Florian, Siebenrock Klaus Arno
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland.
ArthroClinic Bern, Lindenhofspital, Bremgartenstrasse 117, 3012, Bern, Switzerland.
Arch Orthop Trauma Surg. 2025 Apr 5;145(1):224. doi: 10.1007/s00402-025-05821-z.
Bone wax is a haemostatic agent, widely used to prevent bleeding from bone surfaces. Despite its effectiveness in haemostatic control, it can lead to foreign body granuloma and osteolysis. Therefore, the aim of this study was to assess the rate and progress of osteolysis after surgical bone wax application.
We included 425 patients between 01/2002 and 12/2006 that underwent offset correction for cam type femoroacetabular impingement with application of bone wax for homogeneous statistical cohort formation. Comparison was made to a similar cohort group undergoing offset correction without application of bone wax, including 479 patients between 01/2008 and 12/2012. Out of the study group, six hips in five patients presented with persisting pain and growing osteolysis on the X-rays in the area of the offset correction, and two underwent subsequent revision surgery. None of the patients in the cohort group presented with osteolysis. In both groups, patients who presented with persisting pain without radiological osteolysis had other determinable causes as labral tears, progressing osteoarthritis, trochanteric bursitis, and adhesions as suggested source of the pain. We measured the relative area of the osteolysis where present (area of osteolysis/area of femoral head in %) on lateral radiographs on the first postoperative X-rays and latest follow-up X-rays, with a mean follow-up time of 8.6 ± 2.5 years (range, 5-13 years). Histologic samples were taken at revision surgery.
The relative area of osteolysis increased in all hips from a directly postoperative median of 5.5% ± 2.7% (2.3-10.7%) to 11.2% ± 3.9% (7.1-17.3%) at last follow-up. In patients undergoing revision surgery for osteolysis, remaining wax as a foreign material with attached multinucleated giant cells and abundant mononuclear cells was detected histologically.
The intra-articular use of bone wax should be approached with caution and with awareness of the possible complications.
KEK 2018-00078, registered April 2018.
level IV, retrospective case series.
骨蜡是一种止血剂，广泛用于防止骨表面出血。尽管其在止血控制方面有效，但它可能导致异物肉芽肿和骨质溶解。因此，本研究的目的是评估手术应用骨蜡后骨质溶解的发生率和进展情况。
我们纳入了2002年1月至2006年12月期间接受凸轮型股骨髋臼撞击症偏移矫正并应用骨蜡以形成同质统计队列的425例患者。将其与2008年1月至2012年12月期间接受偏移矫正但未应用骨蜡的类似队列组进行比较，该队列组包括479例患者。在研究组中，5例患者的6个髋关节在偏移矫正区域的X线片上出现持续疼痛和骨质溶解增加，其中2例接受了后续翻修手术。队列组中没有患者出现骨质溶解。在两组中，出现持续疼痛但无放射学骨质溶解的患者有其他可确定的原因，如盂唇撕裂、进行性骨关节炎、转子滑囊炎和粘连，这些被认为是疼痛的来源。我们在术后第一张X线片和最新随访X线片的侧位片上测量了存在骨质溶解的相对面积（骨质溶解面积/股骨头面积，以%表示），平均随访时间为8.6±2.5年（范围5 - 13年）。在翻修手术时采集组织学样本。
所有髋关节骨质溶解的相对面积从术后直接测量的中位数5.5%±2.7%（2.3 - 10.7%）增加到最后随访时的11.2%±3.9%（7.1 - 17.3%）。在因骨质溶解接受翻修手术的患者中，组织学检查发现残留的蜡作为异物，附着有多核巨细胞和丰富的单核细胞。
关节内使用骨蜡应谨慎，并应意识到可能的并发症。
KEK 2018 - 00078，2018年4月注册。
IV级，回顾性病例系列。
