Hip-preserving reconstruction of the proximal femur with a vascularized fibula autograft and liquid-nitrogen-treated tumor bearing bone

Abstract

Primary bone malignancies in children pose numerus challenges for orthopedic oncology surgeons. Limb salvage surgery is widely preferred, and biological reconstruction methods such as the vascularized autografts, allografts, radiated or frozen tumor bearing autografts bear the advantage of preserving children's own anatomy. [1][2][3][4] In such cases, conserving the joint and epiphysis may potentially improve the outcome of otherwise debilitating surgeries. [1] In this article, we present a pediatric case of epiphysissparing biological reconstruction of the proximal femur. CASE REPORTA five-year-old male patient who had a twomonth-old history of inability to bear weight with the left lower extremity presented to our A five-year-old boy with Ewing sarcoma of the proximal femur was operated at our institution with limb-sparing surgery and biological reconstruction of the proximal femur with a vascularized fibular autograft. During this procedure, the proximal femur was soaked in liquid nitrogen which was subsequently fixed to the fibular autograft, while the epiphysis of the femoral head was spared. To the best of our knowledge, this is the first report of epiphysis-sparing surgery of the proximal femur via a vascularized fibular autograft surrounded by a liquid nitrogen-treated tumor bearing bone autograft. Three years postoperatively, the patient remains disease-free, has a full weight-bearing extremity with good function, and a remodeled proximal femur with minimal deformity. There are no radiological or clinical signs indicative of femoral head osteonecrosis. In conclusion, hip-sparing biological reconstruction is a successful method of limb preservation as an alternative to tumor endoprostheses.

A comparison of cemented and cementless intra-neck curved stem use during hip-preserving reconstruction following massive femoral malignant tumor removal

“…The preservation of native hip joints can lower the risk of muscle damage, surgical disruption, and articular surface degeneration relative to the use of endoprosthetic hip joints, thereby improving the overall function of the lower extremities in treated patients. Alternative approaches to hip-preserving reconstruction (HPR) following MFMT resection include the use of inactivated autologous bone grafts ( 7 ), osteoarticular allografts ( 8 ), combined autografts and allofraft ( 9 , 10 ), and endoprostheses. Inactivated autologous bone grafted has the advantage of anatomical matching, biological reconstruction, relatively low cost, and no need for large bone bank support; however, inactivated bone fracture, infection, non-union, and internal fixation failure are the disadvantages of this technique ( 7 ).…”

Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes

“…The surgical removal of large femoral malignancies can yield short femoral metaphyseal juxta-articular segments that can be difficult to accurately reconstruct ( 1 ). Reconstructive approaches in these patients include total femur replacement (TFR) ( 2 ), the use of inactivated autologous bone grafts ( 3 ), osteoarticular allografts ( 4 ), or a combination of both autografts and allofrafts ( 5 , 6 ). While TFR can obviate the need to amputate the affected limb and is associated with positive functional outcomes during the early stages of patient follow-up, this procedure is often associated with undesirable outcomes including infection, local recurrence, aseptic loosening, hip disarticulation, and limb-length discrepancies ( 2 , 7 , 8 ).…”