Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb

Abstract

We determined the efficacy of a devitalised autograft (n = 13) and allograft (n = 16) cortical strut bone graft combined with long-stem endoprosthetic reconstruction in the treatment of massive tumours of the lower limb. A total of 29 patients (18 men:11 women, mean age 20.1 years (12 to 45) with a ratio of length of resection to that of the whole prosthesis of > 50% were treated between May 2003 and May 2012. The mean follow-up was 47 months (15 to 132). The stem of the prosthesis was introduced through bone graft struts filled with cement, then cemented into the residual bone. Bone healing was achieved in 23 patients (86%). The mean Musculoskeletal Tumour Society functional score was 85% (57 to 97). The five-year survival rate of the endoprostheses was 81% (95% confidence intervals 67.3 to 92.3). The mean length of devitalised autografts and allografts was 8.6 cm (5 to 15), which increased the ratio of the the length of the stem of the prosthesis to that of the whole length of the prosthesis from a theoretical 35% to an actual 55%. Cortical strut bone grafting and long-stem endoprosthetic reconstruction is an option for treating massive segmental defects following resection of a tumour in the lower limb. Patients can regain good function with a low incidence of aseptic loosening. The strut graft and the residual bone together serve as a satisfactory bony environment for a revision prosthesis, if required, once union is achieved.

Advances in tumour endoprostheses: a systematic review

“…25 Therefore, augmented systems with osteoarticular allografts may be used, as described by Qu et al in a study on 29 patients treated with cortical strut bone grafts combined with long-stem endoprosthetic reconstruction in the knee joint. 26 In their study, bone healing was observed in 23 of 29 patients reconstructed with cortical strut allografts in addition to tumour endoprostheses after a mean of 3.9 years. 26…”

“…26 In their study, bone healing was observed in 23 of 29 patients reconstructed with cortical strut allografts in addition to tumour endoprostheses after a mean of 3.9 years. 26…”

Hip-Preserved Reconstruction Using a Customized Cementless Intercalary Endoprosthesis With an Intra-Neck Curved Stem in Patients With an Ultrashort Proximal Femur: Midterm Follow-Up Outcomes

“…Because of accurate preoperative imaging techniques, early diagnosis, and effective chemotherapy, femoral diaphyseal tumors with a long proximal femoral extension can be segmentally resected with joint preservation ( Zekry et al, 2017 ). Alternative surgical reconstruction options include the induced membrane technique ( Masquelet and Begue 2010 ; Accadbled et al, 2013 ), distraction osteogenesis ( Subasi and Kapukaya 2003 ), autografts ( Qu et al, 2015a ; Houdek et al, 2017 ), allografts ( Aponte-Tinao et al, 2018 ; Houdek et al, 2018 ), combined autografts and allografts ( Capanna et al, 2007 ), and customized intercalary endoprostheses ( Hanna et al, 2010 ; Stevenson et al, 2017 ). The induced membrane technique is an alternative method for lesions of the upper limb, and this method can prevent graft resorption and induce the secretion of growth factors.…”

Development of a Three-Dimensional (3D) Printed Biodegradable Cage to Convert Morselized Corticocancellous Bone Chips into a Structured Cortical Bone Graft

“…For these reasons, there is an imperious need for bone grafts that can provide both biologic bone healing capacities and mechanical bony supports to decrease the requirement of those bulky implants. In such cases, structural bone grafts like fibular or tri-cortical strut iliac bone grafts are recommended for some bone defect management, especially for those patients with osteoporotic problems [ 11 ].…”