Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic
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ORIGINAL PAPER
Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur İbrahim Tuncay 1 & Remzi Tözün 2 & Orkhan Aliyev 1 & Göksel Dikmen 2 & Gökçer Uzer 1 & Vahit Emre Özden 2 & Fatih Yıldız 1 Received: 10 July 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
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. Keywords Fibula . Autograft . Allograft . Hip . Arthroplasty . Periprosthetic fracture . Revision
Introduction Total hip arthroplasty (THA) is known to be one of the most successful orthopaedic procedures in terms of high patient
satisfaction and low complications rates by means of improvements in the surgical techniques and implant technologies. However, as the number of hip replacements and life expectancies increase around the globe, the numbers of revisions or re-
* Fatih Yıldız [email protected]
Gökçer Uzer [email protected]
İbrahim Tuncay [email protected] Remzi Tözün [email protected] Orkhan Aliyev [email protected] Göksel Dikmen [email protected]
Vahit Emre Özden [email protected] 1
Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul 34093, Turkey
2
Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar Unive
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