Clinical and functional outcomes of neo-adjuvant zoledronic acid therapy and valgus osteotomy in proximal femoral fibrous dysplasia

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2026-01-01 Epub Date: 2025-11-20 DOI:10.1016/j.jcot.2025.103277

Nitish Jagdish Jyoti , Pon Aravindhan, Ritvik Janardhanan, Dyuti Deepta Rano, Love Kapoor, Shah Alam Khan

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引用次数: 0

Abstract

Background

Fibrous dysplasia (FD) is characterised by structurally weak bone due to disorganized fibro-osseous matrix, leading to pain, deformities and pathological fractures. While traditional treatments like curettage and bone grafting are ineffective due to graft resorption and lesion persistence, intramedullary fixation is currently preferred method to prevent recurrent deformities and fractures. This study aimed to evaluate the clinical and functional outcomes of neo-adjuvant zoledronic acid (ZA) therapy combined with valgus osteotomy in proximal femoral FD, and to assess changes in neck-shaft angle (NSA) and limb length discrepancy (LLD).

Methods

This single centre, retrospective study included eight patients with proximal femoral monostotic/polyostotic FD treated between January 2021 and December 2023. All patients received three doses of intravenous ZA at 4-week intervals, followed by valgus osteotomy performed 8 weeks after the final ZA dose. Pre- and post-operative NSA and LLD were recorded and compared. Functional outcomes were assessed using the modified Guille criteria.

Results

The mean age was 21.8 ± 6.68 years. Three patients had monostotic and 5 had polyostotic FD. Mean follow-up was 24.5 ± 6.4 months. All patients experienced pain relief post-ZA without serious adverse events, although only 2 showed radiological improvement. The mean modified Guille score improved from 3.5 ± 1.51 to 8.25 ± 1.48 (p = 0.01). The mean NSA improved from 100.75 ± 17.05° to 125.75 ± 8.31° (p = 0.044) and LLD reduced from 1.93 ± 0.72 cm to 0.93 ± 0.49 cm (p < 0.001). Union was achieved in all cases with a mean healing time of 6.25 ± 1.66 months.

Conclusion

Combining neo-adjuvant ZA therapy and valgus osteotomy offers significant functional improvement and deformity correction in proximal femoral FD. While ZA offers consistent pain relief, its radiological impact remains variable. Valgus osteotomy, stabilized with intra- or extramedullary fixation remains a valuable technique for managing FD-associated deformities. Further prospective studies are warranted to refine treatment protocols and validate long-term outcomes.

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新辅助唑来膦酸治疗和外翻截骨治疗股骨近端纤维发育不良的临床和功能结果

纤维发育不良（FD）的特征是由于纤维-骨基质紊乱导致骨结构薄弱，导致疼痛、畸形和病理性骨折。由于移植物吸收和病变持续存在，传统的治疗方法如刮痧和植骨是无效的，髓内固定是目前预防复发性畸形和骨折的首选方法。本研究旨在评价新辅助唑来膦酸（ZA）联合外翻截骨治疗股骨近端FD的临床和功能结果，并评估颈轴角（NSA）和肢体长度差异（LLD）的变化。方法本研究为单中心回顾性研究，纳入了2021年1月至2023年12月期间接受治疗的8例股骨近端单侧/多侧FD患者。所有患者每隔4周接受三次静脉注射ZA，最后一次ZA给药后8周进行外翻截骨。记录术前、术后NSA和LLD并进行比较。功能结果采用改良的吉尔标准进行评估。结果患者平均年龄21.8±6.68岁。单纯性FD 3例，多骨性FD 5例。平均随访24.5±6.4个月。所有患者术后疼痛缓解，无严重不良事件，仅有2例影像学改善。改良吉尔平均评分由3.5±1.51分提高至8.25±1.48分（p = 0.01）。平均NSA从100.75±17.05°提高到125.75±8.31°（p = 0.044）， LLD从1.93±0.72 cm降低到0.93±0.49 cm （p < 0.001）。所有病例均愈合，平均愈合时间为6.25±1.66个月。结论新辅助ZA联合外翻截骨术对股骨近端FD有明显的功能改善和畸形矫正作用。虽然ZA提供持续的疼痛缓解，但其放射学影响仍然是可变的。外翻截骨，髓内或髓外固定稳定仍然是治疗fd相关畸形的一种有价值的技术。需要进一步的前瞻性研究来完善治疗方案并验证长期结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.