Consolidation of massive bone allografts in limb-preserving operations for bone tumours

Aranguren, Mikel San Julián; Leyes, Manuel; Mora, Guillermo; Cañadell, J.

doi:10.1007/bf00178354

Cited by 27 publications

(9 citation statements)

References 36 publications

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“…A review of literature reveals lower nonunion rates for combined allograft and vascularised fibula reconstructions (up to 31%) in comparison to allograft alone (nonunion in up to 46%) (Tables 1 and 2) [11, 12, 14, 20, 22, 23, 27, 30–38, 54]. Among our twelve patients, four developed nonunion.…”

Section: Discussionmentioning

confidence: 82%

“…Ten-year graft survival rates of approximately 80% had been reported (range 53% to 84%) [8, 14–16, 18]. Long-term results of several study groups report a steady state without deterioration of the graft if the allograft endures the first three years, suggesting that it will thereafter remain functional for the duration of patient's life [9, 11, 12, 16, 18, 22, 49–51, 53, 54]. Good functional long-term results are achieved with intercalary allografts, but associated complications as nonunion, fracture, and infection are frequent (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

Rabitsch

Maurer-Ertl

Pirker-Frühauf

et al. 2013

Sarcoma

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Reconstruction with massive bone allograft and autologous vascularised fibula combines the structural strength of the allograft and the advantages of fibula's intrinsic blood supply. We retrospectively analysed the outcome of twelve patients (4 male, 8 female) who received reconstruction with massive bone allograft and autologous vascularised fibula after tumour resection in lower limb. Mean age was 17.8 years (range 11–31 years), with following primaries: Ewing's sarcoma (n = 6), osteosarcoma (n = 4), liposarcoma grade 2 (n = 1), and adamantinoma (n = 1). Mean followup was 38.7 months (median 25.7 months; range 2–88 months). Seven tumours were located in the femur and five in the tibia. The mean length of bone defect was 18.7 cm (range 15–25 cm). None of the grafts had to be removed, but there occurred four fractures, four nonunions, and two infections. Two patients developed donor side complication, in form of flexion deformity of the big toe. The event-free survival rate was 51% at two-year followup and 39% at three- and five-year followup. As the complications were manageable, and full weight bearing was achieved in all cases, we consider the combination of massive bone allograft and autologous vascularised fibula a stable and durable reconstruction method of the diaphysis of the lower limbs.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

Rabitsch

Maurer-Ertl

Pirker-Frühauf

et al. 2013

Sarcoma

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“…The consolidation time for allografts has been reported as being 9 to 15 months. 19,28 Aranguren et al 31 have also observed faster consolidation in the metaphysis than in the diaphysis in allografting (6.5 vs 16 months). Ceruso et al 32 reported a similar mean consolidation time of eight months with allografts combined with a vascularised fibular graft.…”

Section: Discussionmentioning

confidence: 92%

Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery

Krieg

Davidson

Stalley

2007

The Journal of Bone and Joint Surgery. British volume

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Between 1996 and 2003, 16 patients (nine female, seven male) were treated for a primary bone sarcoma of the femur by wide local excision of the tumour, extracorporeal irradiation and re-implantation. An additional vascularised fibular graft was used in 13 patients (81%). All patients were free from disease when reviewed at a minimum of two years postoperatively (mean 49.7 months (24 to 96). There were no cases of infection. Primary union was achieved after a median of nine months (interquartile range 7 to 11). Five host-donor junctions (16%) united only after a second procedure. Primary union recurred faster at metaphyseal junctions (94% (15) at a median of 7.5 months (interquartile range 4 to 12)) than at diaphyseal junctions (75% (12) at a median of 11.1 months (interquartile range 5 to 18)). Post-operatively, the median Musculoskeletal Tumour Society score was 85% (interquartile range 75 to 96) and the median Toronto Extremity Salvage score 94% (interquartile range 82 to 99). The Mankin score gave a good or excellent result in 14 patients (88%). The range of movement of the knee was significantly worse when the extracorporeally irradiated autografts were fixed by plates rather than by nails (p = 0.035). A total of 16 (62%) of the junctions of the vascularised fibular grafts underwent hypertrophy, indicating union and loading. Extracorporeal irradiation autografting with supplementary vascularised fibular grafting is a promising biological alternative for intercalary reconstruction after wide resection of malignant bone tumours of the femur.

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“…Deijkers et al ( 40 ) revealed that the mean consolidation time was 17 months in diaphyseal junctions, and 13.4 months in metaphyseal junctions. San Julian Aranguren et al ( 46 ), identified that the mean consolidation time for the diaphyseal allograft reconstruction was 16 months, and systemic chemotherapy or external radiotherapy delayed consolidation. Brunet et al ( 47 ) reported that the cumulative probability of union was only 46% (95% CI, 0–99%) at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis

Lun

Yang

et al. 2018

Oncol Lett

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Reconstruction of bone defects following femoral diaphyseal tumor resection is challenging. Segmental allograft (SA) and intercalary prosthesis (IP) are the most common reconstruction methods for femoral diaphyseal metastatic tumors with pathological fracture. However, whether the complications and functional outcomes differ between SA and IP remains unclear. To compare the clinical outcomes and complications for patients treated with SA reconstruction or IP replacement for femoral shaft tumors, 34 patients who had undergone intercalary resection for metastatic tumor with pathological fracture in the femoral diaphysis were evaluated. Of these, 18 had received SA and 16 IP. There were 11 males, and 24 females, with a mean age of 64.5±11.3 years. The most common sites of primary metastases were lung (26.5%), breast (17.6%) and liver (14.7%). The visual analog scale (VAS), implant-related complications and the Musculoskeletal Tumor Society (MSTS) scores for each patient were collected. The follow-up period for patients ranged from 2 to 27 months. At the most recent follow-up, 28 patients had succumbed to mortality, with a mean survival time of 6.9±3.7 months for the IP group and 7.4±3.0 months for the SA group. Patients with IP had a significantly shorter time to full weight bearing and hospitalization time than those who received SA (P=0.003 and P=0.002, respectively). The rates of overall complications and implant-related complications were significantly lower for IP as compared with SA (18.8 vs. 66.7%, P=0.007; 12.5 vs. 55.6%, P=0.013). The reoperation rate of the SA group was higher than that of the IP group (38.9 vs. 12.5%), however the difference between the two groups was statistically insignificant (P=0.125). MSTS scores were significantly higher for the IP group as compared with the SA group at one month after surgery (IP, 26.7±1.6 vs. SA, 20.3±1.5; P<0.05), without a significant difference at the final follow-up. There were no statistically significant differences in age, sex, length of resection, follow-up time, operative time or blood loss between the two groups. In summary, IP reconstruction may provide improved early functional outcomes and fewer early complications, particularly for patients with a shorter life expectancy due to femoral metastatic tumors with pathological fracture.

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Consolidation of massive bone allografts in limb-preserving operations for bone tumours

Cited by 27 publications

References 36 publications

Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery

Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis

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