Reconstruction with biological methods following intercalary excision of femoral diaphyseal tumors

Abstract

The aim of this study was to assess outcomes of biological (nonvascularized fibula grafts and extracorporeal irradiated autologous bone grafts) methods used for reconstruction of intercalary defects after resection of femoral diaphyseal tumors. Materials and Methods: This study included 28 patients who had undergone intercalary resection in femoral diaphyseal tumors between 2011 and 2016. The mean follow-up period was 24 months (range 12-57 months). Results: The mean union time for diaphyseo-diaphyseal union was 10.5 and 11 months in nonvascularized fibula group and extracorporeal radiotherapy (ECRT) group, respectively. The mean union time for metaphyseo-diaphyseal union was 6.5 months in both nonvascularized fibula and ECRT groups. Six patients had distant metastasis, and one patient had local recurrence. The mean Musculoskeletal Tumor Society score was 28 at the last follow-up. Two patients had surgical site infection in the nonvascularized fibula group. Implant failure was found in one patient of the ECRT group requiring revision surgery. Three patients had nonunion (two from the nonvascularized fibula group and one from the ECRT group). Conclusion: The present study indicates that the biological reconstruction modalities provide good functional outcomes in diaphyseal tumors of femur. Nonvasularized fibula and ECRT-treated autografts reconstruction provides good results, and union timing is comparable. The outcomes of the current study are promising as compared to the results in the reviewed literature. The reconstruction method depends on the resources available at the oncological center and the conversance with the method of the treating surgeon.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

“…A subgroup of studies focused specifically on the Capanna technique 72 , 74 , reporting a primary union rate of 82.7%, in an average time of 7.6 months, a complication rate of 43.8%, a reintervention rate of 25.3%, and a failure rate of 8%. For non-vascular fibular grafts 37 , 70 , 75 , 80 the mean primary union rate was 73.0%, with a complication rate of 49.0% and a reintervention rate of 42.0%.…”

“…The fibular graft was the elective technique in 19 studies 37 , 42 , 43 , 66 – 81 , for a total of 327 patients (mean age 22.2 years): the inferior limb was involved in 81.3% of the cases, while the upper limb accounted for 18.7% of the cases. The defect was exclusively due to tumor resection in nine studies, trauma in four studies, and non-union after previous treatment in three studies, while three studies reported mixed aetiology.…”

Factors Influencing Nonunion and Fracture Following Biological Intercalary Reconstruction for Lower‐Extremity Bone Tumors: A Systematic Review and Pooled Analysis

“…Two studies retrospectively compared outcomes between endoprosthetic reconstruction and intercalary allograft 27,28 . The remaining five comparative studies evaluated graft characteristics in allograft versus irradiated autograft, 11 allograft versus pasteurized autograft, 29 free versus pedicled vascularized fibular graft, 30 allograft versus Capanna technique, 22 and nonvascularized fibula graft versus irradiated autograft 31 . The characteristics of individual studies are shown in Supplementary Table I and data from the pooled analysis are summarized in Table 1.…”

Assessment of the Viability and Union Feature of Diaphysis Reconstruction Using Pasteurized Tumor Bone and Intramedullary Free Fibular After Tumor Resection

“…[1][2][3] Biological reconstruction methods include allograft, nonvascularized fibular graft (VFG) or VFG, combined allograft and autograft (such as the Capanna technique), and autologous bone graft using devitalized tumor bone. 4,5 Although intercalary segmental endoprostheses can provide immediate stability, early weight bearing, and good short-term postoperative function, they are associated with high mechanical failures including implant wear and loosening and breakage during long-term follow-up. 3,6 Furthermore, large segmental defect adjacent to a joint renders the use of conventional intramedullary stem fixation for endoprosthetic reconstruction infeasible.…”

“…Intercalary allografts are currently the most widely accepted reconstruction method, but they are reportedly associated with substantial rates of complications including nonunion (16% to 57%), fracture (17% to 30%), and infection (10% to 18%). 1,2,4,[7][8][9][10] Creeping substitution involves neovascularization of the grafts, and it has been suggested that mechanical problems are associated with revascularization or ingrowth of an allograft. 1,11 In one long-term follow-up study the reconstruction failure rate was 21% at 15 years.…”