Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children

Abstract

Limb salvage surgery has become the standard treatment for malignant primary bone tumors in the extremities. Limb salvage represents a challenge in skeletally immature patients. Several treatment options are available for limb reconstruction after tumor resection in children. We report our results using the technique of epiphyseal sparing and reconstruction with frozen autograft bone in 18 children. The mean follow-up period for the all patients included in this study is 72 ± 26 m. Eight patients remained disease-free, seven patients lived with no evidence of disease, two were alive but with disease, and one patient died of the disease. Five- and ten-year rates of survival were 94.4%. Graft survival at 5 and 10 years was 94.4%. Functional outcome using the Enneking scale was excellent in 17 patients (94.4%) and poor in one patient (5.5%). Complications include 2 nonunions, 2 fractures, 2 deep infections, 1 soft tissue recurrence, and leg length discrepancy in 7 cases. This technique is a good reconstructive choice in a child with a nonosteolytic primary or secondary bone tumor, responsive to chemotherapy, without involvement of the articular cartilage. It is a straight forward, effective, and biological technique, which affords immediate mobilization of joints and possible cryoimmune effects, with excellent long term functional outcome and less complication.

What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee?

“…Three of our patients (7%) experienced local recurrence, which was comparable to a mean local recurrence of 6.9% (range, 0%-18%) reported in series of limb salvage procedures [13,19,22,30,45]. The three recurrences were located away from the joint-end osteotomy site; two of the relapsed tumors encased a major vessel (femoral vessels and posterior tibia vessels), and one is near the posterior tibial nerve.…”

“…In addition, there have been attempts to improve contiguous joint function by means of intercalary resection after physeal distraction [5,6], transepiphyseal resection [13,30,32], or multiplanar osteotomy [4], preserving the entire or part of the articular surface. We have tried multiple adjuvant techniques including navigation [25,27], microwave ablation [23], and argon-based ablation [24] to aid joint-sparing tumor resection, with the goal of exploring a surgical strategy to maximize the chance of joint preservation with full consideration of a safe resection margin, important structures such as the ACL and PCL, articular cartilage, and subchondral bone reservation, and preservation of the joint.…”

Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

“…ere was also a frequent need for revision surgery as well as, prolonged protected weight bearing after surgery and longer rehabilitation. e incidence of all major complications encountered in biological reconstruction ranges from 32 to 47% [2,[7][8][9][10][11][12][13], with similar revision rates. Furthermore, in many techniques used in bone allograft reconstruction, the fixation plate will cause premature epiphysiodesis and early closure of the epiphyseal plate, with no attempt at preserving the growth potential of the growing bone and subsequent need for bone elongation procedures Table 3 [7].…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…5 ). The free freezing technique involves two osteotomies [ 101 ] and soft tissue removal by immersion of neoplastic bone in liquid nitrogen [ 99 , 100 ]. The pedicle freezing technique requires a single osteotomy or joint dislocation on the proximal side of the tumour-bearing bone [ 102 ].…”