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Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 19-25

Risk factors for focal osteolysis in a stainless-steel limb-lengthening device

International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

Correspondence Address:
Dr. Philip Kraus McClure
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, Maryland 21215
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jllr.jllr_17_21

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Background: Magnetic, telescoping intramedullary lengthening devices are widely used for treatment of limb length discrepancies. However, a routine radiographic review of a stainless-steel device demonstrated soft tissue and bony changes suggestive of osteolysis. Therefore, we sought to examine all patients implanted with a stainless-steel limb-lengthening nail. We specifically asked: (1) what is the incidence of periosteal reaction osteolysis? (2) Is a new biologic reaction classification system valid and reliable? and (3) Are there predictive factors for the development of osteolysis? We hypothesized that higher patient weight and femoral insertion would be risk factors for lysis, due to increased bending moments on the implants. Materials and Methods: A retrospective review of all patients implanted with a stainless-steel limb-lengthening nail between December 2018 and December 2020 was conducted at a single institution. A total of 57 nails in 44 patients were radiographically examined with an average follow-up of 6.2 months (range: 1–21 months). The incidence of osteolysis was calculated through review of patient radiographs. These were then classified according to a novel system by five fellowship-trained orthopedic surgeons with agreement assessed using an intraclass correlation coefficient (ICC). Logistic regression measured predictive factors for this phenomenon. A separate histologic analysis of two bone/soft-tissue biopsies at the time of routine explantation was conducted by an independent pathologist. Results: The incidence of periosteal reaction and osteolysis was 36.8% and 17.5%, respectively. Nails with progression to osteolysis increased to 34.6% (9/26) when examining nails with at least a 6-month follow-up. ICC testing yielded good inter-rater agreement for the novel classification system (average measure: 0.860, 95% confidence interval 0.828–0.888). Age >16 years (P = 0.024) and body weight >150 pounds (P = 0.038) were predictors of osteolysis. Histologic analysis of the biopsies demonstrated an abundance of particulate debris suggestive of chromium reaction. Conclusions: The modular junction of a stainless-steel lengthening device is susceptible to osteolytic changes, and this appears to be associated with increased age and weight. This phenomenon has an apparent time dependence: osteolysis increases with greater follow-up.

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