Abstract
We retrospectively studied 35 patients who underwent endoprosthetic reconstruction of diaphyseal bone defects after excision of primary sarcomas. The patients were treated between February 1979 and May 1999 and had more than 5 years follow-up. There were 22 males and 13 females and the median age at diagnosis was 29 (8–75) years. The bone defect measured a mean of 19 (10–27.6) cm. There were 29 femoral reconstructions, three tibial and three humeral. Cumulative overall survival for all patients was 65% at 10 years. Cumulative overall survival for prosthetic reconstruction, using revision surgery as an end point, was 63% at 10 years. Cumulative risk of failure of reconstruction, including infection, fracture, aseptic loosening, local recurrence and amputation, was 60% at 10 years. Tibial and humeral reconstructions fared less well than femoral. Endoprosthetic replacement is a useful method of reconstructing long intercalary defects, especially if situated in the femur.
Résumé
Nous avons étudié rétrospectivement 35 malades qui ont subi une reconstruction endoprothétique après excision diaphysaire d’un sarcome primaire. Les malades ont été traités entre février 1979 et mai 1999 et avaient plus de 5 ans de suivi. Il y avait 22 hommes et 13 femmes et l’âge médian au diagnostic était de 29 (8–75) ans. Le défaut osseux mesurait en moyenne 19 (10–27.6) cm. Il y avait 29 reconstructions fémorales, trois tibiales et trois humérales. La survie totale cumulative pour tous les malades était 65% à 10 ans. La survie totale cumulative pour la reconstruction prothétique, en utilisant la chirurgie de révision comme élément final, était de 63% à 10 ans. Le risque cumulatif d’échec en incluant: l’infection, la fracture, le démontage aseptique, la récidive locale et l’amputation étaient de 60% à 10 ans. Les reconstructions tibiales et humérales sont allées moins bien que les fémorales. Le remplacement endoprothétique est une méthode utile pour reconstruire de longues pertes de substance intercalaires, surtout si elles sont situées sur le fémur.
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References
Abudu A, Carter SR, Grimer RJ (1996) The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Joint Surg Br 78:652–657
Alman BA, De Bari A, Krajbich JI (1995) Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. J Bone Joint Surg Am 77:54–64
Blunn GW, Briggs TW, Cannon SR, Walker PS, Unwin PS, Culligan S, Cobb JP (2000) Cementless fixation for primary segmental bone tumor endoprostheses. Clin Orthop 372:223–230
Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop 421:232–239
Donati D, Capanna R, Campanacci D, Del Ben M, Ercolani C, Masetti C et al (1993) The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study. Chir Organi Mov 78:81–94
Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ (1991) The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop 270:181–196
Gidumal R, Wood MB, Sim FH, Shives TC (1987) Vascularized bone transfer for limb salvage and reconstruction after resection of aggressive bone lesions. J Reconstr Microsurg 3:183–188
Goldberg VM, Stevenson S (1987) Natural history of autografts and allografts. Clin Orthop 225:7–16
Han CS, Wood MB, Bishop AT, Cooney WP III (1992) Vascularized bone transfer. J Bone Joint Surg Am 74:1441–1449
Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP et al (2001) Factors affecting nonunion of the allograft–host junction. Clin Orthop 382:87–98
Kulkarni A, Fiorenza F, Grimer RJ, Carter SR, Tillman RM (2003) The results of endoprosthetic replacement for tumours of the distal humerus. J Bone Joint Surg Br 85:240–243
Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM (2003) Endoprosthetic replacement of the proximal humerus. Long-term results. J Bone Joint Surg Br 85:717–722
Luzzati A, Mapelli S, Giraldi A (1991) Diaphyseal and metaphyseal hemiresection with autograft reconstruction in the treatment of lowgrade tumors of the long bones. Ital J Orthop Traumatol 17:81–86
Makley JT (1985) The use of allografts to reconstruct intercalary defects of long bones. Clin Orthop 197:58–75
Manfrini M, Vanel D, De Paolis M, Malaguti C, Innocenti M, Ceruso M et al (2004) Imaging of vascularized fibula autograft placed inside a massive allograft in reconstruction of lower limb bone tumors. Am J Roentgenol 182:963–970
Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer 50:613–630
Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 324:86–97
Mnaymneh W, Malinin T (1989) Massive allografts in surgery of bone tumors. Orthop Clin North Am 20:455–467
Ortiz-Cruz E, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ (1997) The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am 79:97–106
Ozaki T, Hillmann A, Wuisman P, Winkelmann W (1997) Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors. Acta Orthop Scand 68:298–301
San Julian AM, Leyes M, Mora G, Canadell J (1995) Consolidation of massive bone allografts in limb-preserving operations for bone tumours. Int Orthop 19:377–382
Thompson RC Jr, Garg A, Clohisy DR, Cheng EY (2000) Fractures in large-segment allografts. Clin Orthop 370:227–235
Wittig JC, Bickels J, Kellar-Graney KL, Kim FH, Malawer MM (2002) Osteosarcoma of the proximal humerus: long-term results with limb-sparing surgery. Clin Orthop 397:156–176
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Aldlyami, E., Abudu, A., Grimer, R.J. et al. Endoprosthetic replacement of diaphyseal bone defects. Long-term results. International Orthopaedics (SICOT) 29, 25–29 (2005). https://doi.org/10.1007/s00264-004-0614-6
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DOI: https://doi.org/10.1007/s00264-004-0614-6