Role of impaction bone grafting of allografts in the management of benign lesions of the proximal femur
Rajasekaran RB., Jayaramaraju D., Palanisami DR., Agraharam D., Thippeswamy PB., Rajasekaran S.
Purpose of study: The use of allografts to reconstruct benign lesions of the proximal femur after curettage has seldom been reported. We report our experience of impaction bone grafting of only allografts combined with osteosynthesis to manage benign lesions involving the proximal femur. Materials and methods: Between 2013 and 2019, 35 patients of a mean age of 23.8 years (14–41) who had a biopsy proven benign pathology and a median pre-operative Mirels’ score of 9 (8–11) were managed using extended curettage, impaction bone grafting of allografts combined with osteosynthesis through a lateral approach. Radiographs were assessed to see for any recurrence at follow-ups, and functional outcomes were assessed using Musculoskeletal Tumour Society (MSTS) score and Harris hip score (HHS). Results: At a mean follow-up was 41.5 months (23–80), patients demonstrated favorable functional outcomes with a mean MSTS of 28.3 (18–30) and a mean HHS of 94.3 (66–100) at the last follow-up. Two cases (GCT = 1; fibrous dysplasia = 1) had a recurrence of disease. Allografts demonstrated a particular integration pattern on radiographs that involved an intermediate period of lucency followed by consolidation and integration with the parent bone. Conclusion: Impaction grafting of allografts in benign lesions of the proximal femur allows adequate bony consolidation of the cavity after extended curettage and can be effectively used as a permanent solution to manage such lesions in most cases. The intermediate period of lucency seen on radiographs must not be confused for recurrence, and patients must be followed up continuously. Study design: Retrospective Case Series. Level of evidence: Level IV.