Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur

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.

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature

“…Lastly, bone grafting should be considered for patients with poor bone stock or major femoral bone defects. Some authors have addressed the need to use cortical fibula onlay autografts in cases of poor bone stock, reporting clinical and radiological results comparable to allografts ( 60 , 61 ). Autograft incorporation would be more rapid, cost-effective, and easy to achieve without severe morbidity at the donor site than the allograft ( 60 ).…”

“…Second, the analysis may be limited by potential publication bias. Third, all these studies were case series, and different MTTS were used for THR in PFF; this does not allow for a precise analysis of the overall survival of the different modular stems ( 60 , 62 ). However, the causes of THR were the same in all the included studies, and this systematic review provides the strongest available evidence in the literature to date.…”

Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study

“…This study showed that cortical allograft strut augmented with platelet-rich plasma could successfully treat long bone nonunions in the lower limb. Although autografts were fresh viable tissues with cancellous parts and the bone marrow, which were not only osteoconductive but also osteoinductive and osteogenic grafts, cortical allografts also have some superiority to autografts in terms of larger and longer size and more significant defects [ 7 ]. These echoed the findings of earlier research, and PRP seemed, to some extent, an attractive biological to enhance fracture healing [ 23 ].…”

“…The cortical strut allograft was generally used for advanced age patients, severe osteoporosis, bone defect, short transverse fracture and the discontinuity of medial femoral cortex, especially the position where the plate could not be placed due to proximity to certain vessels and nerves [ 6 ]. Cortical allografts were generally larger and longer than autografts in size and, therefore, can be used in more significant defects [ 7 ]. Although allogeneic bone is not comparable to the autogenous bone in osteogenesis, bone conductivity, bone induction, and fixation stability, allogeneic bone is accessible [ 8 ].…”