Functional, Oncological, and Radiological Outcomes Following Safe Surgical Dislocation for the Treatment of Locally Aggressive Proximal Femoral Lesions

Abstract

Study Type: Retrospective cohort study. Background and Purpose: Locally aggressive lesions of the proximal femur represent a spectrum of pathologies in the younger age group, which result in large defects. Safe surgical dislocation (SSD) is one of the viable surgical approaches to achieve optimal visualization and clearance of tumor. This study looks at the functional, oncological, and radiological outcomes following SSD for the treatment of locally aggressive proximal femoral lesions. Materials and Methods: A retrospective study was done in Orthopedics Unit 3 at our tertiary care center between 2015 and 2021 on patients who underwent SSD for the treatment of biopsy confirmed locally aggressive proximal femur lesions. The inclusion criteria were age more than 15 years, with biopsy confirmed symptomatic locally aggressive lesions of the proximal femoral region with a minimum 1 year follow-up. The clinical parameters were reduction in pain, restoration of hip movements, abductor strength, and ability to weight bear and resumption of activities of daily living. Graft consolidation, status of implant, local recurrence, trochanteric nonunion, and appearance of avascular necrosis included as radiological parameters. The functional parameters were assessed through the modified Musculoskeletal Tumor Society Score and the nonarthritic Young Hip Score. Results: Ten cases of biopsy-proven proximal femoral lesions (out of 15 such cases) fulfilling the inclusion criteria were enrolled. All ten underwent intralesional excision/extended curettage of lesion, followed by auto/allograft reinforcement to fill the defect and internal fixation using SSD as surgical approach. The choice of graft and fixation method was based on surgeon’s preference. Functional and radiographic assessment was done on follow-up, with an average follow-up of 13 months (range 12–14 months). The mean nonarthritic Young Hip Score improved from 49 (±8.96) preoperatively to 85.4 (±11.95) at the time of review, and the modified Musculoskeletal Tumor Society Score improved from a mean of 23.3 (±0.83) preoperatively to 28.4 (±1.07) at the time of review. There was no tumor recurrence and avscular necrosis at the time of follow-up. Allograft consolidation was seen in 8 out of 10 cases at the time of review. Conclusion: SSD is an excellent approach to achieve optimal tumor clearance. Good functional and radiological outcomes are seen if adequate tumor clearance is obtained and reconstruction with stable internal fixation is achieved. Tumor recurrence and avascular necrosis were not noted in any of the cases at 1-year (intermedial) follow-up.

Keywords

• outcomes
• proximal femoral lesions
• safe surgical dislocation