Surgical management of fibrous dysplasia: recurrence and functional outcomes based on MSTS and TESS evaluation

Fibrous dysplasia (FD) is a benign bone disorder with variable clinical presentation and controversial management strategies. This study aimed to evaluate the clinical characteristics, surgical outcomes, recurrence rates, and functional results of patients with FD using Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) systems. A retrospective analysis was conducted on 62 patients who underwent surgical treatment for FD between 2000 and 2022 at a tertiary referral center. Demographic data, clinical characteristics, presenting complaints, surgical methods, graft use, and recurrence were evaluated. Functional outcomes were assessed using MSTS and TESS scores. Statistical analyses were performed to determine factors affecting recurrence and functional outcomes. The mean age was 28.77 ± 14.72 years. Pain was the most common presenting complaint (50.0%). The proximal femur was the most frequently affected site (33.9%), and most lesions involved the lower extremity (82.3%). Recurrence occurred in 13 of 62 cases (21.0%) and was associated with presenting complaint ( p = 0.001), being more common in patients presenting with pain. No significant association was found between recurrence and surgical method or graft use ( p > 0.05). Mean MSTS and TESS scores were 90.56 ± 11.55 and 88.49 ± 9.86, respectively. Exploratory comparisons did not identify significant differences by surgical method or graft use. Surgical treatment of FD provides favorable functional outcomes with low complication rates. Clinical presentation and disease type significantly influence functional results and recurrence, whereas surgical technique and grafting do not appear to affect outcomes.