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Intercalary reconstruction of the femur after tumour resection.

Abstract Aims After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction. Patients and Methods A total of 23 patients with a mean age of 16 years (five to 40) who had undergone resection of an intercalary bone tumour of the femur and reconstruction with a VFG and allograft were reviewed clinically and radiologically. The mean follow-up was 141 months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29). Full weight-bearing without a brace was allowed after a mean of 13 months (seven to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score of 22 evaluable patients was 94% (73 to 100). Eight major complications, five fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%). Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and nonunion needing surgery as failure endpoints. Overall survival, with removal of allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15 years. Discussion There were no complications needing surgical revision after five years had elapsed from surgery, suggesting that the mechanical strength of the implant improves with time, thereby decreasing the risk of complications. In young patients with an intercalary bone tumour of the femur, combining a VFG and massive allograft may result in a reconstruction that lasts a lifetime. Cite this article: Bone Joint J 2018;100-B:378-86.
PMID
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Authors

Mayor MeshTerms
Keywords

Allograft

Femur

Intercalary reconstruction

Limb salvage

Tumour resection

Vascularized fibular graft

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589494
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - Intercalary reconstruction of the femur after tumour resection.
PG  - 378-386
LID - 10.1302/0301-620X.100B3.BJJ-2017-0283.R2 [doi]
AB  - Aims After intercalary resection of a bone tumour from the femur, reconstruction 
      with a vascularized fibular graft (VFG) and massive allograft is considered a
      reliable method of treatment. However, little is known about the long-term
      outcome of this procedure. The aims of this study were to determine whether the
      morbidity of this procedure was comparable to that of other reconstructive
      techniques, if it was possible to achieve a satisfactory functional result, and
      whether biological reconstruction with a VFG and massive allograft could achieve 
      a durable, long-lasting reconstruction. Patients and Methods A total of 23
      patients with a mean age of 16 years (five to 40) who had undergone resection of 
      an intercalary bone tumour of the femur and reconstruction with a VFG and
      allograft were reviewed clinically and radiologically. The mean follow-up was 141
      months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29).
      Full weight-bearing without a brace was allowed after a mean of 13 months (seven 
      to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score 
      of 22 evaluable patients was 94% (73 to 100). Eight major complications, five
      fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%).
      Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and
      nonunion needing surgery as failure endpoints. Overall survival, with removal of 
      allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15
      years. Discussion There were no complications needing surgical revision after
      five years had elapsed from surgery, suggesting that the mechanical strength of
      the implant improves with time, thereby decreasing the risk of complications. In 
      young patients with an intercalary bone tumour of the femur, combining a VFG and 
      massive allograft may result in a reconstruction that lasts a lifetime. Cite this
      article: Bone Joint J 2018;100-B:378-86.
FAU - Campanacci, D A
AU  - Campanacci DA
AD  - Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda
      Ospedaliera Universitaria Careggi, Florence, Italy.
FAU - Totti, F
AU  - Totti F
AD  - Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda
      Ospedaliera Universitaria Careggi, Florence, Italy.
FAU - Puccini, S
AU  - Puccini S
AD  - Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda
      Ospedaliera Universitaria Careggi, Florence, Italy.
FAU - Beltrami, G
AU  - Beltrami G
AD  - Department of Paediatric Orthopaedic Oncology, Azienda Ospedaliera Universitaria 
      Careggi.
FAU - Scoccianti, G
AU  - Scoccianti G
AD  - Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda
      Ospedaliera Universitaria Careggi, Florence, Italy.
FAU - Delcroix, L
AU  - Delcroix L
AD  - Department of Plastic Surgery and Microsurgery, Azienda Ospedaliera Universitaria
      Careggi.
FAU - Innocenti, M
AU  - Innocenti M
AD  - Department of Plastic Surgery and Microsurgery, Azienda Ospedaliera Universitaria
      Careggi.
FAU - Capanna, R
AU  - Capanna R
AD  - Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria
      Pisana, Pisa, Italy.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Femoral Neoplasms/*surgery
MH  - Fibula/*transplantation
MH  - Fracture Fixation, Internal/*methods
MH  - Humans
MH  - Male
MH  - Reconstructive Surgical Procedures/*methods
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Allograft
OT  - Femur
OT  - Intercalary reconstruction
OT  - Limb salvage
OT  - Tumour resection
OT  - Vascularized fibular graft
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0283.R2 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):378-386. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0283.R2.