Hemicortical allograft reconstruction after resection of low-grade malignant bone tumours

Abstract

Low-grade surface tumours of bone may theoretically be treated by hemicortical resection, retaining part of the circumference of the cortex. An inlay allograft may be used to reconstruct the defect. Since 1988 we have performed 22 hemicortical procedures in selected patients with low-grade parosteal osteosarcoma (6), peripheral chondrosarcoma (6) and adamantinoma (10). Restricted medullary involvement was not a contraindication for this procedure. There was no evidence of local recurrence or distant metastasis at a mean follow-up of 64 months (27 to 135). Wide resection margins were obtained in 19 patients. All allografts incorporated completely and there were no fractures or infections. Fractures of the remaining hemicortex occurred in six patients and were managed successfully by casts or by osteosynthesis. The functional results were excellent or good in all except one patient. Hemicortical procedures for selected cases of low-grade surface tumours give excellent oncological and functional outcomes. There was complete remodelling and fewer complications when compared with larger intercalary procedures. The surgery is technically demanding but gives good clinical results.

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

“…With the navigation guidance, we could reproduce the planned resection without any help of landmark measurements or intraoperative fluoroscopy. Some authors have reported the use of multiplanar osteotomies or hemicortical resection to treat select patients with bone sarcoma [1,3,5]. Our results in Patients 1, 5, 6, and 8 also suggest multiplanar osteotomies or hemicortical resection are possible around bone tumors.…”

Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas

“…Given the high risk of local recurrence with a contaminated margin [2] and the resulting poor prognosis, many physicians are reluctant to perform a resection that achieves less than generously wide margins [1,2]. In contrast, some authors have reported no local recurrences and no nonunions, with a resection technique used for low-grade surface osteosarcomas that retains part of the cortical circumference [1,8,19]. This technique, termed hemicortical or hemicylindrical resection, removes the tumor while maintaining a portion of the host cortex to enhance healing and function [1,8,19].…”

“…In contrast, some authors have reported no local recurrences and no nonunions, with a resection technique used for low-grade surface osteosarcomas that retains part of the cortical circumference [1,8,19]. This technique, termed hemicortical or hemicylindrical resection, removes the tumor while maintaining a portion of the host cortex to enhance healing and function [1,8,19]. In high-grade tumors near joints, one report suggests trying to save the articular surface by performing a transepiphyseal osteotomy [23].…”

Treatment of a Humeral Metastasis with a Composite Allograft-Prosthetic Reconstruction

“…Combining the advantages of the reversed shoulder prosthesis with our experience in limb-saving procedures for malignant bone tumors and metastases of the hip or knee prompted us to choose an allograft-reversed prosthesis reconstruction [7][8][9][10]14]. Because of the length of the prosthetic stem, we were able to bridge the allograft and achieve stable fixation in the distal part of the humerus.…”