Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

Abstract

Background and Objectives. Osteoarticular extracorporeal irradiated autograft is an alternative operation technique to prosthetic devices or allografts for reconstruction after resection of bone malignancies. The aim of this study is to assess the complications, radiographic changes, and functional outcomes of osteoarticular ECIA. Methods. We retrospectively reviewed 33 patients who underwent osteoarticular ECIA after bone tumor resection from 1988 to 2014. We investigated complications, radiographic changes by the International Society of Limb Salvage graft evaluation criteria, and functional outcomes according to the Musculoskeletal Tumor Society scoring system. Results. Fifteen patients were reoperated upon due to infection (n = 9), protruding fixation implant (n = 4), or fracture of the grafted bone (n = 2). The average radiographic evaluation score was 66.4%, and the median functional score was 23 (77%). The radiographic score for the proximal humerus or proximal tibia was lower than that for the other locations. The functional score was not different among the autograft sites but was related to the radiographic score. Conclusion. Although osteoarticular ECIA is one of the reasonable surgical options for patients with tumors for which reliable prostheses are not available, we do not recommend osteoarticular ECIA as a routine procedure because of high complication rate.

Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

“…Though there are various reconstruction techniques described which aim to provide a stable and functional elbow, there is a lack of consensus regarding the method of choice. Anatomical reconstructions like the use of osteo-articular graft and recycled tumor bone seem to provide good initial function but are associated with availability issues and higher delayed complication (2,22). Non-anatomical reconstruction like radial transposition to humeral trochlea, though durable are plagued with restricted function (3,5,7,9,10).…”

“…Both these options require a unique infrastructure for graft processing and are associated with complications like osteotomy healing, wound healing issues, graft resorption, late graft fractures and instability (4,6,22). These techniques may not be suitable in cases that require adjuvant radiation for adequate oncological control.…”

Pelvic Chondrosarcoma Treated by En Bloc Resection with Patient-Specific Osteotomy Guides and Reimplantation of the Extracorporeally Irradiated Bone as an Osseocartilaginous Structural Orthotopic Autograft: A Report of Two Cases with Description of the Surgical Technique

“…Chan et al [ 36 ] reported no infections in their series of nine patients with type 2 periacetabular resections who were reconstructed with ECI-recycled autograft and endoprosthetic replacement. Takenaka et al [ 37 ] found a significantly high rate of complications in their series of 33 patients but their cohort consisted of autografts from various locations, like proximal humerus, proximal tibia, scapula, and only three acetabula. We believe, as they also stated in their paper, that the high heterogeneity in autograft location, method of fixation, and tumor type which also necessitated chemotherapy might have influenced the incidence and type of complications in their series.…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…Irradiation consists of 60–70 Gy in a single dose [ 88 , 90 ]. A limitation of this procedure is that the irradiated bone fragments have no blood supply and this can lead to infections, fractures, non-union, and bone re-absorption [ 90 , 91 ]. To avoid this problem, a vascularized bone graft can be associated with the irradiated bone fragment, improving reconstruction and increasing vascularization [ 4 , 89 , 90 ].…”