Can bone scintigraphy predict the final outcome of pasteurized autografts?
OBJECTIVE
As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters.


METHODS
Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing.


RESULTS
Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic "tramline appearance". Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases.


CONCLUSIONS
Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas.
Eid
Ahmed Shawky
AS
Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt.
Jeon
Dae-Geun
DG
Cho
Wan Hyeong
WH
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000000981:diagnostic imaging*; D002648:Child; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011183:Postoperative Complications / Q000175:diagnosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013242:Sterilization; D013669:Technetium Tc 99m Medronate; D016896:Treatment Outcome; D055815:Young Adult
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate