Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Abstract

Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups. We retrospectively reviewed 85 patients (mean age, 22 years; range, 4-82 years), 38 (45%) of whom had a condyle-sparing allograft and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2-19 years). Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having allografts. Using time to local recurrence as an end point, the Kaplan-Meier

What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee?

“…Some authors believe one basic criterion for epiphyseal-sparing tumor resection is that the distance between the articular joint cartilage and the tumor as assessed by MRI should be 2 cm or more, to obtain a bone width margin at least of 1 cm [3,32,45]. We previously reported that cotreatments of cryoablation, microwave ablation, and navigation-assisted osteotomy could make entire or partial epiphyseal-sparing resection possible even when a tumor invades the epiphysis [ [23][24][25][26][27].…”

“…Previous studies have shown that the prevalence of transepiphyseal spread of the tumor in metaphyseal osteosarcomas is approximately 80% [37,39]. Despite controversies, some authors believe that the end of the joint should be resected along with the tumor when the tumor invades the epiphysis for the safety of local tumor control [29,32,45]. Amputation or complete excision of the tumor along with the joint followed by endoprosthetic reconstruction offers the best chance for local control, but endoprostheses present subsequent reconstructive complications.…”

“…Zimel et al [45] reported joint-sparing intercalary resection combined with appropriate biologic reconstruction had better durability compared with endoprosthetic reconstruction. In addition, there have been attempts to improve contiguous joint function by means of intercalary resection after physeal distraction [5,6], transepiphyseal resection [13,30,32], or multiplanar osteotomy [4], preserving the entire or part of the articular surface.…”

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

“…Although fractures were common in our series, the intramedullary free fibula allowed the fractures to heal with ORIF or nonoperatively, which could not occur in an allograft alone. Infection has been shown to occur in 5% to 18% of allografts [2,8,33,36,43]. Although a majority of our patients in our series were undergoing chemotherapy, which has been shown to increase the risk of infection [11], we did not have any postoperative infectious complications.…”

“…This appears to be a higher percentage of patients achieving this level of function than has been previously reported after the Capanna technique or with the use of massive allografts alone where good to excellent Mankin scores were only seen in 49% to 74% of patients [2,6,17,21]. Although initially structurally superior to fibular grafts, the use of large cortical intercalary allografts for lower extremity limb salvage has been reported to have a high rate of complications as a result of the avascular nature of the graft including nonunion, infection, and fracture [5,17,29,33,34,36,43]. Previous studies have shown that the outer surface of the allografts becomes populated with living cells; however, the inner allograft remains acellular [4,6,22].…”