Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults.

PURPOSE: Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). METHODS: Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. RESULTS: The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. CONCLUSION: The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.

Clinical and Radiological Outcomes of Hallux Rigidus Treated With Cheilectomy and a Moberg-Akin Osteotomy.

BACKGROUND: This study aimed to evaluate the clinical and radiological outcome after cheilectomy and proximal phalangeal biplanar osteotomy for patients with mild and advanced stages of hallux rigidus. METHODS: A total of 105 feet (grades 0-4) were treated with cheilectomy and a Moberg-Akin osteotomy of the proximal phalanx. All patients were clinically assessed preoperatively and followed up for 12 months by range of motion, visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Short Form 36 (SF-36) score, and weightbearing radiographs. RESULTS: This operative procedure resulted in a statistically significant positive effect on mobility of the first metatarsophalangeal joint (P = .001), VAS pain score (P < .001), AOFAS score (P < .001), and SF-36 score (P < .001). CONCLUSION: Cheilectomy and biplanar osteotomy of the proximal phalanx was an effective procedure for hallux rigidus with a positive effect on clinical and radiological outcome. LEVEL OF EVIDENCE: IV, case series.