Hemicortical Resection and Inlay Allograft Reconstruction for Primary Bone Tumors

Bus, Michaël P. A.; Bramer, Jos A. M.; Schaap, Gerard R.; Schreuder, H.W.B.; Jutte, Paul C.; Geest, I.C.M. van der; Sande, Michiel A. J. van de; Dijkstra, P. D. S.

doi:10.2106/jbjs.n.00948

Cited by 31 publications

(21 citation statements)

References 43 publications

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“…2), which have presumably higher consolidation rates due to the larger contact area as well as the lower extent of soft tissue dissection [7]. Similar to our results, comparable studies on hemicortical reconstructions with auto- or allografts following tumour resection showed lower non-union rates of only 0–7% [7, 33–36]. …”

Section: Discussionsupporting

confidence: 87%

“…This is in accordance with reports in the literature, where the superiority of vascularised fibulae over non-vascularised grafts was reported for bone defects longer than 12 cm as indicated by failure rates of 25% and 50%, respectively, [38]. The significantly lower mechanical complication rate of hemicortical reconstructions ( p = 0.013) in our series might be explained—beside the above mentioned factors such as the limited extent of soft-tissue dissection and a greater contact surface between graft and host bone—by the preservation of cortical continuity [7]. Taking our own results into account, we therefore strongly recommend the use of vascularised fibula grafts for segmental bone defects of 12 cm or greater.…”

Section: Discussionmentioning

confidence: 59%

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Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

Lenze

Kasal

Hefti

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts.MethodsWe retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years).ResultsPrimary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%).ConclusionsDue to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 59%

Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

Lenze

Kasal

Hefti

et al. 2017

BMC Musculoskelet Disord

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“…The most frequent complication in this study was host bone fracture, with a reported rate of 15% to 27% in previous studies that evaluated more than 10 patients (8-10, 13). First, perfect fitting of the allograft may reduce fracture rate (8,15). Contrary to the allograft, it is relatively easy to obtain perfect cortical apposition between the irradiated autologous bone and host cortices at the junction.…”

Section: Discussionmentioning

confidence: 99%

“…However, non-union in intercalary reconstructions using extracorporeal irradiated autologous bone grafts with vascularized fibular grafts has been reported to occur in 7-31% of all patients (5)(6)(7). In contrast, hemicortical resection and reconstruction using allograft or autograft for selected bone and soft tissue malignant tumors yield excellent oncologic and functional outcomes (8)(9)(10)(11). Hemicortical resection may be also indicated for a soft tissue sarcoma (STS) attached to the surface of the bone.…”

mentioning

confidence: 99%

The Clinical Outcomes of Hemicortical Extracorporeal Irradiated Autologous Bone Graft After Tumor Resection of Bone and Soft Tissue Sarcoma

et al. 2019

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Background/Aim: We analyzed the process of healing at osteotomy sites and timing of achievement of full weight-bearing in sarcoma patients who underwent hemicortical or intercalary reconstruction using the extracorporeal irradiated autologous bone graft technique. Patients and Methods: We studied 10 patients who had undergone tumor resection and reconstruction with hemicortical extracorporeal irradiated autologous bone graft at mid-shaft femur or tibia. The control group consisted of 30 patients who received the reconstruction using intercalary bone graft. Results: Full weight-bearing was achieved in all 10 patients at a median time of 4.8 months. Function was excellent in all patients. When comparing the clinical outcome among the patients who received intercalary and hemicortical grafts, the duration to full weight-bearing achievement in patients who received hemicortical graft was shorter than that in those with intercalary graft. Conclusion: Early full weight-bearing may be achieved in patients undergoing hemicortical resection and reconstruction using extracorporeal irradiated autologous bone graft.

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“…Segmental resection in a young child is associated with a high complication rate like fractures in hemicortical resection in 6 of 22 patients [1]. Ingrowth of the reconstruction allograft can be better if CAS is used for a better fit [2], however in general the reconstruction with allograft has high complication rates of up to 40% pseudarthrosis, infection and fracture [3]. To avoid these complications it would be ideal to spare the continuity of tibial bone by treating the tumor in situ.…”

Section: Introductionmentioning

confidence: 99%

CAS guided RFA can be a safe and effective treatment in OFD like adamantinoma in a child.

Jutte¹,

Ploegmakers²

EPiC Series in Health Sciences

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BackgroundOsteo Fibrous Dysplasia (OFD) like adamantinoma is considered a benign condition that is usually located in the tibia. The condition is mainly found in children and has an association with classical adamantinoma, a malignancy of bone. The preferred treatment is surgical.The lesion often requires a segment resection to eradicate the tumor as the margins of healthy bone are often too small to save continuity of bone and the lesion is located in the cortical area. Segmental resection in a young child is associated with a high complication rate.To avoid these complications it would be ideal to spare the continuity of tibial bone by treating the tumor in situ. Radiofrequency Ablation (RFA) may be a safe and reliable option for treatment of OFD like adamantinoma, without vital tumor spill.To ensure accurate ablation, the guidance and monitoring of antenna placement, planning and execution are performed with computer assisted surgery (CAS).ResultsTwo young patients with OFD like adamantinoma of the tibia were treated with CAS guided open intra-operative RFA in our institution. Because of the heat generation and the proximity of the skin we performed the procedures half open. In both patients successful local tumor ablation was achieved without complications. At baseline MRI there was no sign of residual tumor activity in either patient.DiscussionFollow-up is short and number of treated patients too low to draw definitive conclusions yet.What we can say is that there is considerable less damage done to the patient if compared to classical open surgery like segmental resection or hemicortical resection.Another great advantage is that it allows accurate local tumor ablation without tumor spill and it does not prohibit a local resection as a plan b if there still is viable local tumor tissue visible on MRI. It allows classical treatment in case of insufficient ablation.ConclusionLocal tumor ablation with RFA has the potential to become a safe and effective treatment alternative in OFD like adamantinoma in a child.

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Hemicortical Resection and Inlay Allograft Reconstruction for Primary Bone Tumors

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 31 publications

References 43 publications

Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

The Clinical Outcomes of Hemicortical Extracorporeal Irradiated Autologous Bone Graft After Tumor Resection of Bone and Soft Tissue Sarcoma

CAS guided RFA can be a safe and effective treatment in OFD like adamantinoma in a child.

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