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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 3, 366-371.
doi: 10.1302/0301-620X.89B3.18508  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery

A. H. Krieg, MD, Orthopaedic Surgeon1; A. W. Davidson, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon2; and P. D. Stalley, FRCS, Orthopaedic Surgeon, Head of Department3

1 Orthopaedic Department, University Children’s Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland.
2 Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
3 Orthopaedic Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.

Correspondence should be sent to Dr A. H. Krieg; e-mail: andreas.krieg{at}ukbb.ch

Between 1996 and 2003, 16 patients (nine female, seven male) were treated for a primary bone sarcoma of the femur by wide local excision of the tumour, extracorporeal irradiation and re-implantation. An additional vascularised fibular graft was used in 13 patients (81%). All patients were free from disease when reviewed at a minimum of two years postoperatively (mean 49.7 months (24 to 96).

There were no cases of infection. Primary union was achieved after a median of nine months (interquartile range 7 to 11). Five host-donor junctions (16%) united only after a second procedure. Primary union recurred faster at metaphyseal junctions (94% (15) at a median of 7.5 months (interquartile range 4 to 12)) than at diaphyseal junctions (75% (12) at a median of 11.1 months (interquartile range 5 to 18)).

Post-operatively, the median Musculoskeletal Tumour Society score was 85% (interquartile range 75 to 96) and the median Toronto Extremity Salvage score 94% (interquartile range 82 to 99). The Mankin score gave a good or excellent result in 14 patients (88%).

The range of movement of the knee was significantly worse when the extracorporeally irradiated autografts were fixed by plates rather than by nails (p = 0.035).

A total of 16 (62%) of the junctions of the vascularised fibular grafts underwent hypertrophy, indicating union and loading.

Extracorporeal irradiation autografting with supplementary vascularised fibular grafting is a promising biological alternative for intercalary reconstruction after wide resection of malignant bone tumours of the femur.






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