Bone Graft for Large Bone Cysts of the Femoral Neck in Patients on Hemodialysis

Pathologic fracture of the femoral neck from an amyloid bone cyst in patients on long-term hemodialysis causes substantial morbidity. For patients with a bone cyst occupying more than 1/2 of the neck width, we have performed prophylactic internal fixation with an autogenous iliac bone graft. We describe our surgical technique and present clinical results from consecutively surgically treated patients. We determined whether our procedure successfully induced healing of the bone cyst, thus preventing a problematic sequel of fracture. From 1990 to 2003, 14 hips in 12 patients were treated, and the clinical results from these patients were retrospectively reviewed. One patient died 3 months after surgery; the remaining patients were followed for at least 3 years. In those 11 patients, bony healing was achieved in all cases with no recurrence of the cystic lesion. Considering the comparatively unsatisfactory results of internal fixation for pathologic fracture and THA for patients receiving long-term hemodialysis, our procedure gives surgeons another option for treating this difficult problem.