Risk Factors for Complications in Reconstructing Congenital Femoral Deficiency

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.

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.

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.

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.