Surgical reconstruction of fibrous dysplasia of bone in long-term follow-up.

Purpose: To examine how different operative measures influence the surgical outcome in patients with fibrous dysplasia of bone. Methods: 118 dysplasti c fibrous lesions of bone were surgically treated and reviewed in 70 patien ts between 1983 to 1993 (eleven years) with a median follow-up of six and a half years. Surgery consisted of intralesional curettage in 93 and margina l en bloc resection in 25 lesions. Bony defects were reconstructed with aut ogenous iliac crest graft in 55 lesions, with autogenous fibula graft in 9, with homologous bone chips in 28, and 5 times with a homologous fibula gra ft from the bone bank. In 33 lesions the entire defect was filled with poly methylmethacrylate. Osteosynthesis was performed in 41 patients. Results: R ecurrences requiring surgical revision were observed in 26 of 74 primary le sions (= 35% overall recurrence rate) at a mean 123.6 weeks postoperatively . The most frequent primary and recurrence location was the proximal femur (85% revision rate). 69% of all recurrences occurred under the age of 20. A fter intralesional curettage the reoperation rate was 32% and after margina l resection 8%. After reconstruction with autogenous iliac crest graft recu rrence rate was 36%, after autogenous fibula graft 55%, after homologous bo ne chips 18%, after polymethylmethacrylate 9% and allograft fibula reconstr uction showed no recurrences. A combined stable osteosynthesis bridging the fibrous osseous defect significantly reduced the revision rate to 3% (p = 0.01). Conclusion: Intralesional curettage and reconstruction with autogeno us iliac crest graft in fibrous dysplasia of bone leads to a high recurrenc e rate. Reconstruction with cortical grafts or bone chips from the bone ban k, if necessary in combination with a durable osteosynthesis in mechanicall y demanding locations, or solely bone cement in mechanically less demanding areas, reduces the revision Fate in patients with monoostotic and polyosto tic fibrous dysplasia.