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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 6, 851-857.
doi: 10.1302/0301-620X.87B6.15950  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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En-bloc resection, extracorporeal irradiation, and re-implantation in limb salvage for bony malignancies

A. W. Davidson, FRCSEd(Tr & Orth), Orthopaedic Oncology Fellow; A. Hong, MMed, PhD, Consultant Radiation Oncologist; S. W. McCarthy, FRCPA, Consultant Pathologist; and P. D. Stalley, FRACS, Consultant Orthopaedic Oncologist

The New South Wales Bone and Soft Tissue Sarcoma Service, The Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia.

Correspondence should be sent to Mr A. W. Davidson at 94 Barons Court Road, Fulham, London W14 9DX, UK; e-mail: alastair_davidson{at}hotmail.com

We treated 50 patients with bony malignancy by en-bloc resection, extracorporeal irradiation with 50 Gy and re-implantation of the bone segment.

The mean survivor follow-up was 38 months (12 to 92) when 42 patients were alive and without disease. There were four recurrences. The functional results were good according to the Mankin score (17 excellent, 13 good, nine fair, three failures), the Musculoskeletal Tumour Society score (mean 77) and the Toronto Extremity Salvage score (mean 81). There was solid union, but bone resorption was seen in some cases. The dose of radiation was lethal to all cells and produced a dead autograft of perfect fit.

Extracorporeal irradiation is a useful technique for limb salvage when there is reasonable residual bone stock. It allows effective re-attachment of tendons and produces a lasting biological reconstruction. There should be no risk of local recurrence or of radiotherapy-induced malignancy in the replanted bone.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General