Reconstruction after intercalary resection of malignant bone tumours

Abstract

We reviewed 29 patients who had undergone intercalary resection for malignant tumours. Of these, 14 had received segmental allograft reconstruction and 15 extracorporeally-irradiated autograft. At a mean follow-up of 71 months (24 to 132), 20 were free from disease, five had died and four were alive with pulmonary metastases. Two patients, one with an allograft and one with an irradiated autograft, had a local recurrence. Reconstruction with extracorporeally-irradiated autograft has a significantly lower rate of nonunion (7% vs 43%, p = 0.031) but an insignificantly higher rate of fracture (20% vs 14%, p = 0.535) than that with segmental allograft. Using the Enneking functional evaluation system, the mean postoperative score for the patients without local recurrence was 87% (80% to 96%) and was similar in both groups. Extracorporeally-irradiated autograft could be an acceptable alternative for reconstruction after intercalary resection, especially in countries where it is difficult to obtain allografts.

The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection

“…Reconstruction of segmental bone defects after intercalary resection of the femur may be performed with endoprostheses [3,4], distraction osteogenesis [10], allografts [5][6][7][8] and autologous grafts [11][12][13][14]. Custom-made intercalary endoprostheses have the advantage of allowing early mobilisation and return to function.…”

“…We believe that perfect anatomical reduction and stable fixation are the most important factors in promoting healing of the junction. Previous reported studies of intercalary reconstructions of the femur with re-implanted extracorporeal sterilised bones have largely combined the re-implanted bone with vascularised fibular autografts [11][12][13][14], and we ourselves have done this when resecting the mid tibia [21].…”

“…Non-union in intercalary reconstructions with extracorporeal irradiated autologous bone grafts with vascularised fibular grafts has been reported to occur in between 7 % and 31 % of patients [11][12][13]. Chen et al reported that reconstruction with extracorporeal irradiated autologous bone graft had a significantly lower rate of non-union than that with segmental allograft [12].…”

“…Intercalary resection of the diaphysis for bone tumour has many advantages, as opposed to excision of the end of the long bone, including preservation of joint function, more reliable bone reconstruction and preservation of the epiphyses in children. The options for reconstruction of the defect after intercalary resection in the femur include endoprosthetic replacements [3,4], biological reconstruction either with allograft [5][6][7][8], vascularised or non-vascularised fibular autologous grafting [9], distraction osteogenesis [10] or more recently, sterilisation and reimplantation of the excised bone [11][12][13][14].…”

“…This technique enables biological reconstruction with a precise fit, helps to restore function and avoids long-term complications of endoprosthetic replacement such as loosening and breakage [3,4]. Previous reports recommended vascularised fibular graft to supplement the reconstruction with extracorporeal irradiated autologous bone graft because there remained an exact fitting scaffold of dead bone for a long time [9,11,12]. However, vascularised fibular grafts are associated with considerable donor-site morbidity [9].…”