[Clinical results of the treatment of chronic haematogenous osteomyelitis of the femur by operation. A series of 165 cases].

Between 1968 and 1987 the authors treated 165 cases of chronic haematogenous osteomyelitis of the femur by operation. The procedure used combined decompression, sequestrectomy and saucerization in 161 cases, and sequestrectomy alone in 4. Chemotherapy was used in association for between 10 and 60 days. Eleven patients, thought to be healed, were lost to follow-up after 4 months. The remainder were reviewed for between 4 and 252 months, 124 for more than one year. After the first operation 105 lesions (64%) healed completely, while 60 (36%) relapsed. Of these, 48 were treated by further operation and 12 by drainage of the abscess. Nine patients relapsed twice and there were 3 or more relapses in a further 9. When last seen, 147 lesions were healed and 18 had a permanent sinus. Special features in relation to the femur are discussed, including destructive lesions of the knee and hip joints, the high incidence of stiffness of the knee even in the absence of radiographic evidence of destruction (48.5%), and the danger of injuries to the femoral vessels when using an approach through a medial sinus. The frequency of occurrence of lesions on both medial and posterior aspects of the femur has led the authors to recommend definitive surgical approaches, especially the true postero-lateral and antero-medial routes. Unsatisfactory results after operation may be due to the difficulty in performing sequestrectomy in deep and extensive lesions, problems in undertaking adequate saucerization and the lack of muscle to fill the residual cavity.