title: Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery.
abstract: Between 1996 and 2003, 16 patients (nine female, seven male) were treated for a primary bone sarcoma of the femur by wide local excision of the tumour, extracorporeal irradiation and re-implantation. An additional vascularised fibular graft was used in 13 patients (81%). All patients were free from disease when reviewed at a minimum of two years postoperatively (mean 49.7 months (24 to 96). There were no cases of infection. Primary union was achieved after a median of nine months (interquartile range 7 to 11). Five host-donor junctions (16%) united only after a second procedure. Primary union recurred faster at metaphyseal junctions (94% (15) at a median of 7.5 months (interquartile range 4 to 12)) than at diaphyseal junctions (75% (12) at a median of 11.1 months (interquartile range 5 to 18)). Post-operatively, the median Musculoskeletal Tumour Society score was 85% (interquartile range 75 to 96) and the median Toronto Extremity Salvage score 94% (interquartile range 82 to 99). The Mankin score gave a good or excellent result in 14 patients (88%). The range of movement of the knee was significantly worse when the extracorporeally irradiated autografts were fixed by plates rather than by nails (p = 0.035). A total of 16 (62%) of the junctions of the vascularised fibular grafts underwent hypertrophy, indicating union and loading. Extracorporeal irradiation autografting with supplementary vascularised fibular grafting is a promising biological alternative for intercalary reconstruction after wide resection of malignant bone tumours of the femur.
authors.affiliation: Orthopaedic Department, University Children's Hospital UKBB, Basel, Switzerland. andreas.krieg@ukbb.ch
authors.forename: A H
authors.initials: AH
authors.lastname: Krieg
authors.forename: A W
authors.initials: AW
authors.lastname: Davidson
authors.forename: P D
authors.initials: PD
authors.lastname: Stalley
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000637:transplantation; D005360:Fibula / Q000000981:diagnostic imaging / Q000637:transplantation; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D016879:Salvage Therapy / Q000379:methods; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome