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

Abstract

Purpose We report the outcome of intercalary resection of the femoral diaphysis and extracorporeal irradiated autologous bone graft reconstruction, without the use of vascularized fibular graft. Methods Six patients with Ewing sarcoma of the mid-shaft femur who were treated by limb sparing tumour resection and reconstruction with extracorporeal irradiated autologous bone graft with intramedullary cement between 2002 and 2010 were studied. Results Mean age at the time of surgery was ten years (range, four-23). The length of resected femoral bone averaged 23 cm (15-32 cm). The ratio of bone resection length to total femoral length averaged 60 % (56-66 %). The patients had been followed up for between 16 and 79 months (mean, 41 months) at the time of the study. There was no infection nor fracture in this series. Primary union of the distal and proximal osteotomy sites was achieved in three patients. Delayed union of the proximal osteotomy site occurred in one patient that was successfully treated with iliac crest bone grafting. One patient developed non-union at the distal osteotomy site which failed to heal with bone grafting and was therefore converted to endoprosthetic replacement, and another patient was converted to rotationplasty at five months post-surgery because of contaminated margins. Function was excellent in all patients with surviving re-implanted bone. Local recurrence arose in one patient. Conclusion Our experience suggests that cement augmentation of extracorporeal irradiated and re-implanted bone autografts offer a useful method of reconstructing large femoral diaphyseal bone defects after excision of primary malignant bone tumours.

Surgical Technique for Reconstruction of Diaphyseal Defect with Endoprosthesis following Intercalary Resection in Femoral Shaft

“…The options for reconstruction of diaphyseal skeletal defects after excision of bone tumors in the shaft of long bones include the use of autogenous vascularized fibular grafts, autogenous extracorporeally inactivated bone, massive allografts, a combination of autogenous fibular grafts and allografts and intercalary endoprostheses.…”

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

“…Intraoperative extracorporeal irradiation and re-implantation for bone sarcomas was first described by Spira and Lubin in 1968 (1). This technique enables biological reconstruction with a precise fit, helps restore function, and prevents long-term complications of endoprosthetic replacement, such as loosening and breakage (2)(3)(4). 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).…”

Reconstruction with biological methods following intercalary excision of femoral diaphyseal tumors

“…Delayed union of the proximal osteotomy site occurred in one patient, nonunion occurred in one patient at the distal osteotomy site and was converted to endoprosthetic replacement, and another patient was converted to rotationplasty. 40 Nonunion was found in one patient in the ECRT group in the current study, and autologous bone grafting was done and union was achieved. One patient in the nonvascularized fibula group with SSI required wound wash and debridement at frequent intervals and underwent amputation for the persistent infection.…”

“…The average length of the resected femoral bone was 23 cm (15-32 cm), and the average ratio of bone resection length to total femoral length was 60%. 40 Primary union of the distal and proximal osteotomy sites was achieved in three patients. Function was excellent in all patients with surviving reimplanted bone.…”