Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth

Zucchini, Riccardo; Staals, Eric L.; Fiore, Michele; Campanacci, Laura; Giannini, Claudio; Manfrini, Marco; Donati, Davide María

doi:10.1007/s00590-021-03149-z

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…JSLSS permits better limb function by preserving the adjacent native joints and ligaments. Zucchini et al 9 reported a retrospective study of 23 patients with tumour of distal femur, and found that the lower limb dysmetria in transmetaphyseal resection cases was better than transepiphyseal resection cases. In our cases, none of the surviving patients required any assistive walking device, and the median MSTS score at the final follow-up was 28 (IQR 27 to 28), better than that of patients who underwent distal femur arthroplasty in the literature.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…5,6 Joint-sparing limb salvage surgery (JSLSS) enables patients to retain the epiphyseal plate, preserve the growth potential, and provide better lower limb function, which is particularly important for growing children. [7][8][9] Traditionally, reconstruction techniques for diaphyseal bone defects include vascularized fibular autografts, tumour-devitalized bone replantation, massive allografts, and prosthesis reconstruction. 10 These methods can provide durable mechanical strength and are valuable reconstruction strategies.…”

Section: Introductionmentioning

confidence: 99%

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3D-printed modular prostheses for reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours

Zhu,

Hu,

Lin

et al. 2024

Bone Jt Open

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AimsThe aim of this study was to investigate the safety and efficacy of 3D-printed modular prostheses in patients who underwent joint-sparing limb salvage surgery (JSLSS) for malignant femoral diaphyseal bone tumours.MethodsWe retrospectively reviewed 17 patients (13 males and four females) with femoral diaphyseal tumours who underwent JSLSS in our hospital.ResultsIn all, 17 patients with locally aggressive bone tumours (Enneking stage IIB) located in the femoral shaft underwent JSLSS and reconstruction with 3D-printed modular prostheses between January 2020 and June 2022. The median surgical time was 153 minutes (interquartile range (IQR) 117 to 248), and the median estimated blood loss was 200ml (IQR 125 to 400). Osteosarcoma was the most common pathological type (n = 12; 70.6%). The mean osteotomy length was 197.53 mm (SD 12.34), and the median follow-up was 25 months (IQR 19 to 38). Two patients experienced local recurrence and three developed distant metastases. Postoperative complications included wound infection in one patient and screw loosening in another, both of which were treated successfully with revision surgery. The median Musculoskeletal Tumor Society score at the final follow-up was 28 (IQR 27 to 28).ConclusionThe 3D-printed modular prosthesis is a reliable and feasible reconstruction option for patients with malignant femoral diaphyseal tumours. It helps to improve the limb salvage rate, restore limb function, and achieve better short-term effectiveness.Cite this article: Bone Jt Open 2024;5(4):317–323.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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3D-printed modular prostheses for reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours

Zhu,

Hu,

Lin

et al. 2024

Bone Jt Open

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“…One is non-biological reconstruction, which typically involves the use of prosthetics ( Smolle et al, 2019 ). The other method is biological reconstruction (such as allograft ( Zucchini et al, 2022 ), vascularized ( Hsu et al, 1997 ) or nonvascularized fibular graft ( Kaewpornsawan and Eamsobhana, 2017 ), distraction osteogenesis ( Lesensky and Prince, 2017 ), recycling tumor-bearing autograft ( Tsuchiya et al, 2005 )). Due to the inherent growth potential of the unaffected limb being higher than that of the affected limb, patients may experience a discrepancy in limb length when the bones mature.…”

Section: Discussionmentioning

confidence: 99%

A novel non-invasive electromagnetic extendable intercalary endoprosthesis: a proof-of-concept study

Huang,

Yang,

et al. 2024

Front. Bioeng. Biotechnol.

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Introduction: Femur and tibia are the most commonly affected sites for primary malignant bone tumors in children. The wide resection of the tumor frequently requires the physis to be resected. The normal growth of the unaffected limb will result in a significant limb length discrepancy at skeletal maturity. To compensate for this resulting LLD, different generations of extendible endoprostheses have been developed. Non-invasive extendable prostheses eliminate the need for surgical procedures and general anesthesia, enabling gradual and painless lengthening. Currently available non-invasive extendable prostheses focus on joint reconstruction, and no case series analysis of intercalary non-invasive extendable prosthesis has been reported. Therefore, we have designed a novel non-invasive electromagnetic extendable intercalary endoprosthesis.Methods:In vitro mechanical experiments and in vivo animal experiments were conducted.Results:In vitro experiments have confirmed that the prosthetics can extend at a constant rate, increasing by 4.4 mm every 10 min. The average maximum extension force during prosthetic elongation can reach 1306N. In animal in vivo experiments, the extension process is smooth and non-invasive, and the sheep is in a comfortable state.Discussion: The in vitro and in vivo animal studies provide evidence to support the extension reliability, laying the foundation for future large-scale validation experiments.

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Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities

Yang

Feng

et al. 2022

BMC Musculoskelet Disord

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Background For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction. Methods We reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. Results The cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14–76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12–127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6–25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4–18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70–100%). Conclusion Liquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.

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Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth

Cited by 5 publications

References 24 publications

3D-printed modular prostheses for reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours

3D-printed modular prostheses for reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours

A novel non-invasive electromagnetic extendable intercalary endoprosthesis: a proof-of-concept study

Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities

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