Abstract
BackgroundIn order to treat proximal femur fibrous dysplasia (FD) patients combined with hip joint osteoarthritis (OA), the three-dimensional (3D) designing osteotomy and implantation of femoral component was firstly used for deformity correction and total hip arthroplasty (THA). The purpose is to present the detailed design, perioperative management and evaluate short-term clinical outcomes of this novel therapeutic method.MethodA retrospective study was performed in twelve FD patients combined with hip joint OA who were treated in our hospital between July 2013 and April 2015. Seven patients received 3D designing combined osteotomy and THA, and the other five patients underwent 3D designing THA only.ResultsAll patients were followed-up with an average duration of 47 months (range, 35–56 months). There was no infection, dislocation, postoperative wound problems or mechanical failures. For the seven patients receiving 3D designing corrective osteotomy, the mean extremity lengthening was 2.8 (range, 1.5–4) cm. The average duration of bone union was 4.2 months. The average Harris Hip Score was improved from 46.08 (range, 13–67) points preoperatively to 93.72 (range, 83–100) points at the last follow-up. The average modified criteria of Guille was improved from 3.2 (range, 1–7) points preoperatively to 8.6 (range, 6–10) points at the last follow-up.ConclusionsThe 3D designing THA with long uncemented stem, including 3D designing corrective osteotomy and implantation of long prosthesis stem, seems to be a reliable method for FD patients combined with hip joint OA. Through preoperative 3D design, corrective osteotomy and implantation of long prosthesis stem can be precise to re-store alignment, uttermost preserve host bone, obtain primary stem stability and provide necessary condition for long-term stem survival, finally leading to better limb function. Besides, perioperative management should be abided strictly for late stability. Nevertheless, the outcomes of long-term follow-up and larger cases are still required.
Highlights
In order to treat proximal femur fibrous dysplasia (FD) patients combined with hip joint osteoarthritis (OA), the three-dimensional (3D) designing osteotomy and implantation of femoral component was firstly used for deformity correction and total hip arthroplasty (THA)
The 3D designing THA with long uncemented stem, including 3D designing corrective osteotomy and implantation of long prosthesis stem, seems to be a reliable method for FD patients combined with hip joint OA
Patients Twelve patients with proximal femur FD combined with hip joint OA underwent THA with long uncemented stem (solution revision femoral prosthesis (Johnson & Johnson (Shanghai) Medical Device Co., Ltd)) between July 2013 and April 2015 in our hospital
Summary
In order to treat proximal femur fibrous dysplasia (FD) patients combined with hip joint osteoarthritis (OA), the three-dimensional (3D) designing osteotomy and implantation of femoral component was firstly used for deformity correction and total hip arthroplasty (THA). Fibrous dysplasia (FD) is a benign lesion characterized by the replacement of normal bone tissue with immature fibro-osseous tissue leading to widening and thinning of the cortex. It can occur in single bone (monostotic) or multiple bones (polyostotic) [1]. The severity of the deformity and the presence of FD lesions in the peri-articular bones (head of femur and acetabulum) were proven to be independently and closely associated with the development of secondary hip joint OA in these patients [7]. The reported incidence of secondary hip joint OA in patients with proximal femur FD was 13% [7], with the disease progression, the final incidence will highly increase
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