Epidiaphyseal versus other intercalary allografts for tumors of the lower limb

Pasteurized intercalary autogenous bone graft combined with vascularized fibula

The optimal reconstruction procedure after wide resection of bone tumors is debatable. We reviewed pasteurized intercalary autogenous bone graft combined with a vascularized fibula graft in 15 patients with malignant bone tumors, and assessed whether this procedure would improve bone union and function. The mean duration until bone union of the pasteurized autogenous bone was 13.5 months and duration until union of the vascularized fibula was 7.7 months. Complete bone union between the pasteurized autogenous bone and the vascularized fibula eventually was achieved in 13 patients (86.7%). In the remaining two patients, fibula union was achieved but union of the pasteurized autogenous bone was not attributable to infection. Postoperative complications included two fractures and two infections. Three patients with delayed union eventually achieved bone union using an autogenous cancellous bone graft. The mean Musculoskeletal Tumor Society score was 80.6% and it was comparable to scores from other procedures. Our results suggest a pasteurized autogenous bone graft combined with a vascularized fibula graft can be a useful reconstruction method in selected patients with large bone defects after wide resection of malignant bone tumors.

Intercalary endoprosthetic reconstruction for diaphyseal bone tumours

Custom-made intercalary endoprostheses may be used for the reconstruction of diaphyseal defects following the resection of bone tumours. The aim of this study was to determine the survival of intercalary endoprostheses with a lap joint design, and to evaluate the clinical results, complications and functional outcome. We retrospectively reviewed six consecutive patients, three of whom underwent limb salvage with intercalary endoprostheses of the tibia, two of the femur, and one of the humerus. Their mean age was 42 years (28 to 64). The mean follow-up was 21.6 months (9 to 58). The humeral prosthesis required revision at 14 months owing to aseptic loosening. There were no implant-related failures. Musculoskeletal Tumour Society functional outcome scores indicated that patients achieved 90% of premorbid function. Custom intercalary endoprostheses result in reconstructions comparable with, if not better than, those of allografts. Using this design of implant reduces the incidence of early complications and difficulties experienced with previous versions.