Total hip arthroplasty in patients with fibrous dysplasia: a modern update

Abstract

Background: Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. As such, we devised a study assessing the outcomes and complications in patients with FD undergoing THA with modern implant technology, and we outlined our preferred surgical technique.Methods: A search of our institutional arthroplasty database was performed to identify patients who underwent THA for FD between January 2001 and July 2018 at Mount Sinai Hospital in Toronto, Canada. Data regarding implants used and the use of allograft material or metal augments or both were obtained. Complications and revision requirements were noted. Radiographic and clinical leg length discrepancies were assessed.Results: A total of 10 hips in 9 patients who underwent THA for FD were identified. Mean follow-up time was 6.0 years (range 0.5 to 10.3 yr). The majority of patients underwent THA using uncemented femoral and acetabular components with large femoral heads on highly cross-linked polyethylene liners. Most cases (80% of hips) required allograft to the proximal femur. A single complication requiring revision was noted. In 90% of hip surgeries, the patient required transfusion of packed red blood cells. Mean radiographic and clinical leg length discrepancies were 0.9 cm (range -2.4 to 2.4 cm) and 0.9 cm (range -4 to 0 cm), respectively. Conclusion:Contrary to previous reports, low complication and revision rates were observed with cementless components and routine use of allograft material. The challenging nature of such cases warrants use of an experienced arthroplasty treatment team.Contexte : La dysplasie fibreuse (DF) découle d'une anomalie de la formation de l'os lamellaire et affecte le plus souvent le fémur proximal. Elle peut aussi aboutir à l'arthrose qui nécessitera une arthroplastie totale de la hanche (ATH). Or, ces cas sont complexes car on manque d'information sur la meilleure façon de les traiter. Nous avons donc conçu une étude afin d'évaluer l'issue et les complications chez les patients atteints de DF qui subissent une ATH au moyen de techniques d'implants modernes, et nous indiquons la technique chirurgicale que nous privilégions.Méthodes : Nous avons interrogé la base de données de notre établissement sur les arthroplasties pour recenser les patients ayant subi une ATH en raison de la DF entre janvier 2001 et juillet 2018 à l'Hôpital du Mont-Sinaï de Toronto, au Canada. Nous avons obtenu les données sur les implants utilisés et le recours à du matériel de comblement à base d'allogreffes ou de métal ou les deux. Nous avons consigné les complications et les cas où une révision a été nécessaire. Nous avons évalué les inégalités de longueur des membres inférieurs aux plans clinique et radiographique.Résultats : En tout, 10 hanches chez 9 patients ont fait l'objet d'une ATH en raison de la DF. Le...

Total Hip Arthroplasty in a Patient With a Large Proximal Femur Aneurysmal Bone Cyst: A Case Report and Literature Review

“…This is secondary to bone weakness and the large forces acting across the proximal femur. The resulting deviation of the mechanical axis of the hip in turn may lead to the development of adjacent hip osteoarthritis, and a significant number of these patients may require a THA in their lifetime [ 9 , 10 ]. Being aware of the patient’s proximal femur deformity is important for surgical planning with respect to femoral implants and considering osteotomies to address and prevent varus remodeling of the femur.…”

“…On the contrary, Garceau et al. demonstrated low complication and revision rates with cementless components and routine use of cortical strut and proximal femoral allografts [ 10 ]. They also report that with modern conical fluted stems providing better diaphyseal fixation, improved results may be possible with enhanced cementless technology [ 10 ].…”

“…demonstrated low complication and revision rates with cementless components and routine use of cortical strut and proximal femoral allografts [ 10 ]. They also report that with modern conical fluted stems providing better diaphyseal fixation, improved results may be possible with enhanced cementless technology [ 10 ]. In our case, we decided to utilize a long calcar to replace the cemented femoral stem for increased stability, to bypass the lesion, and to provide an extra modality of treatment in hopes of combating recurrence.…”

Bilateral total hip arthroplasty in a case with fibrous dysplasia: a case report

“…Garceau et al studied ten hips with FD that underwent THA, with a mean follow-up of 6 years [ 15 ]. They showed that THA in FD patients is associated with low complication (Two transient sciatic nerve palsies) and revision rates (one hip) using cementless components and allograft.…”

Total Hip Replacements in Patients with Rare Pathologic Conditions Affecting Bone

“…In cases of a solitary lesion involving the proximal part of the femur, curettage of the lesion with autograft impaction is suggested because of its ability to improve osseointegration and prevent loosening 52,70 . Garceau et al 71 reported on THA in 10 hips of 9 patients with FD, 5 of whom had polyostotic disease with considerable involvement of the proximal part of the femur. In 8 hips, allograft material, either cortical strut or proximal femoral allograft, was used in combination with an ETO.…”