Identifying Risk Factors for Revision Surgery After Fassier-Duval Rodding in Osteogenesis Imperfecta Patients: A Large Single-Center Cohort Review.

BACKGROUND

The Fassier-Duval (FD) telescopic rod is the standard of care for treating long bone fractures and deformities in children with osteogenesis imperfecta (OI). Despite its advantages, revision surgery remains common. This study aimed to analyze the medium-to long-term outcomes of FD rodding and identify risk factors for revision surgery.

METHODS

A retrospective review was conducted on all OI patients who received lower limb FD rods between 2009 and 2020. Data on patient demographics, OI type, surgical details, and follow-up were collected. The primary outcome was revision surgery. We used Kaplan-Meier survival analysis and Cox proportional hazards modeling to identify risk factors associated with earlier revision.

RESULTS

The study included 169 operative limbs in 80 patients with a median follow-up of 64 months. The overall revision rate was 36.69%. The most common reasons for revision were refracture (41.94%), recurrence of deformity (29.03%), and rod bending (27.42%). Survival analysis identified the cut point of the age at surgery of ≤30 months ( P =0.0003) and OI type IV ( P =0.034) as significant risk factors for earlier revision. For each additional month of age at surgery, the risk of revision decreased by 1.4% (HR=0.986, 95% CI: 0.979-0.994, P <0.001).

CONCLUSIONS

In our 12-year experience, FD rods demonstrated a medium-term revision rate of ∼37%. Younger age at surgery (≤30 mo) and a diagnosis of OI type IV are critical predictors of earlier implant failure. These findings highlight the unique surgical challenges in the youngest and the more ambulatory OI populations. Further study on surgical technique and implant modification for these very young OI patients is warranted to improve surgical outcomes and implant survival.

LEVELS OF EVIDENCE: Level III-prognostic studies.