Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft

Abstract

Purpose Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. Methods In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG−), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. Results Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. Conclusion Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option.

Comparison of oncological and functional outcomes in Lower-limb osteosarcoma pediatric patients: a large single-center retrospective cohort study

“…As a result, this requires multiple revision surgeries, thus amplifying the financial strain on patients and their families. We suggest that for pediatric patients under the age of 8 diagnosed with lower limb osteosarcoma, in cases where oncological factors permit limb preservation and options for artificial implants are limited due to the patient’s young age, biological reconstruction methods such as bone allograft 25 – 28 and vascularized fiber graft (VFG) 27 , 29 , 30 may improve functional outcomes and a reduced necessity for multiple revision surgeries. Tissue tolerance in pediatric patients increases after the age of 8, thereby making limb salvage surgery using extendable prostheses a viable option.…”

Graft Survivals after Reconstruction Using Tumor-Bearing Frozen Bone in the Extremities

“…In their study, the graft survival rates were 74% at 5 years, 60% at 10 years, and 56% at 20 years. Crenn et al reported that the 5-year graft survival rate was 71% after reconstruction using an allograft without a vascularized fibula graft [24]. In another study of allograft reconstruction for the humerus, the 5-year graft survival rate was 71% [25].…”

Treatment of a case of septic tibial nonunion by the Capanna technique

“…The case presented here is one of the few in the literature where the Capanna technique was used in a non-oncologic indication [ 1 , 3 , [9] , [10] , [11] , [13] , [14] , [15] , [16] , [17] , [18] ]. The technique consists in the use of an allograft strut to reinforce cases where vascularized grafts are at a higher risk of fracture or nonunion as a result of chemotherapy [ 11 , 15 ].…”