Functional results of various reconstruction techniques in primary malignant bone tumors

Ioan-Mihai Japie 1 , Dragoş Rădulescu 1 , 2 , Adrian Bădilă 1 , 2 , Alexandru Papuc 1 , Traian Ciobanu 1 , and Dumitru Stănculescu 2
  • 1 Department of Orthopaedics and Traumatology, University Emergency Hospital, Bucharest, Romania
  • 2 “Carol Davila” University of Medicine and Pharmacy, , Bucharest, Romania

Abstract

Introduction: The aim of the study was to report the clinical and functional outcomes in patients undergoing limb salvage with various reconstruction techniques in primary malignant bone tumor.

Materials and methods: This study was performed between 2011 and 2018 on 52 patients with primary malignant bone tumors admitted to the Department of Orthopaedics and Traumatology of University Emergency Hospital, Bucharest. All the patients underwent surgical treatment (resection-reconstruction technique) followed by oncologic therapy. The mean follow-up was 3 years and 8 months and the minimum follow-up was 12 months.

Results: The best results were obtained in patients in whom resection of the tumor followed by reconstruction was possible, without affecting the adjacent joint through arthrodesis or arthroplasty. These patients had an average MSTS score of 75.2%. The patients who underwent reconstruction procedures by endoprosthesis also had good results with an average MSTS score of 72.3%, while patients with arthrodesis obtained rather modest results – the average MSTS score being 67.3%. When taking into consideration the location of tumors, the best MSTS scores were obtained in patients with tumors of the distal radius – 80%, followed by femoral and humeral diaphysis – 75.6%, distal femur – 75.2%, proximal femur – 73.3%, proximal humerus – 72.3%, tibial diaphysis – 72.2%, distal tibia – 70% and proximal tibia 68.7%.

Conclusions: The orthopedist must judiciously chose the surgical technique, taking into consideration the anatomical particularities and the needs of the patient. Given the functional results and the emotional acceptability, reconstruction with tumor prosthesis represents the first option.

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  • 1. Von Eisenhart-Rothe R, Toepfer A, Salzmann M, Schauwecker J, Gollwitzer H, Rechl H. Primary malignant bone tumors. Orthopade. 2011 Dec;40(12):1121-42.

  • 2. Bacci G, Picci P, Ferrari S et al. Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993;72:3227e3238.

  • 3. Puri A, Byregowda S, Gulia A, Crasto S, Chinaswamy G. A study of 853 high grade osteosarcomas from a single institution are outcomes in Indian patients different?. J. Surg. Oncol. 2018; 117:299–306.

  • 4. Bekmez S, Ayvaz M, Yucekul A, Tokgozoglu M. Modular cementless prosthetic reconstruction after resection of lower extremity malignant tumor. Acta Orthopaedica et TraumatologicaTurcia. 2016; 50:674-680.

  • 5. Capanna R, Scoccianti G, Frenos F, Vilardi A, Beltrami G, Campanacci DA. What Was the Survival of Megaprostheses in Lower Limb Reconstruction After Tumor Resection?. Clin OrthopRelat Res. 2015; 473:820-830.

  • 6. Bilgin S. Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft. J Bone Joint Surg Am. 2012;94(13):e94.

  • 7. Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg Br. 2006;88:1642-6.

  • 8. Xu L, Zhou J, Wang Z, Xiong J, Qiu Y, Wang S. Reconstruction of bone defect with allograft and retrograde intramedullary nail for distal tibia osteosarcoma. Foot and Ankle Surgery. 2018; 24:149-153.

  • 9. Abudu A, Grimer RJ, Tillman RM, Carter SR. Endoprosthetic replacement of the distal tibia and ankle join for aggressive bone tumor. Int Orthop. 1999;23:291-4.

  • 10. Hornicek FJ et al. Factors affecting nonunion of the allograft-host junction. Clin OrthopRelat Res. 2001; (382):87-98.

  • 11. Donati D, Giacomini S, Gozzi E, Sorin E, Borz S, Mercuri M. Knee arthrodesis with a temporary spacer performed in malignant tumor around the knee. Arch Orthop Trauma Surg. 2002;122:123-8.

  • 12. Capanna R, Biagini R, Ruggieri P, Bettelli G, Cascadei R, Campanacci M. Temporary resection-arthrodesis of the knee using an intramedullary rod and bone cement. Int Orthop. 1989;13:253-8.

  • 13. Donati D, Di Liddo M, Zavatta M, Manfrini M, Bacci G, Picci P et al. Massive bone allograft reconstruction in high-grade osteosarcoma. Clin OrthopRelat Res.2000;377:186-94.

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