Risk Factors for Complications in Reconstructing Congenital Femoral Deficiency.

Abstract

Background: Congenital femoral deficiency (CFD) is a rare condition, often associated with other skeletal anomalies that make the management more difficult. This study aimed to present the risk factors associated with complications in reconstruction of CFD.

Methods: This was a retrospective cohort study on patients with CFD who underwent femoral reconstruction between 2002 and 2022, from a single center. The preoperative demographic data, lengthening characteristics, complications, and the predisposing conditions were documented.

Results: Thirty-four patients (24 Aitkin A and 10B CFD cases) had 39 lengthening procedures. Twelve cases had simultaneous leg lengthening for associated fibular hemimelia. The mean achieved length was 10.15 ± 3.89 cm, with 72.73 ± 56.19 months follow-up. Although each procedure had 1.8 ± 1.02 complications, 35.8% bowing of regenerate bone and 28.2% fracture; 17.9% hip and 7.7% knee instability were some of the major ones. Hip instability observed in 7 (17.9%) corelated with Aitken type of CFD, preoperative acetabular index, femoral length discrepancy, and achieved length. Bowing in regenerate bone and poor bone consolidation of 15.4% correlated with simultaneous tibial and femoral lengthening (P = 0.018) and higher initial leg-length discrepancy (P = 0.006). The age at reconstruction did not correlate with the number of complications or healing index (P = 0.68, P = 0.15). Five cases received second-time lengthening. Spanning the knee with fixator during lengthening had no notable association with knee instability.

Conclusion: Femoral reconstruction in CFD is a challenging but effective task, with joint instability, bowing, fracture, and poor consolidation as potential adverse effects that correlate with simultaneous fibular hemimelia treatment besides the achieved length.