J Korean Orthop Assoc.  2007 Jun;42(3):291-297. 10.4055/jkoa.2007.42.3.291.

Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor

• Kim HS
• Kang HG
• Cho JH
• Kim KJ
• Oh JH
• Lee SH

• KMID: 2186551
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.291

Abstract

PURPOSE: This study evaluated the effectiveness of a low-heat treated intercalary autograft reconstruction in primary malignant bone tumors mainly involving the diaphysis.
MATERIALS AND METHODS
Twenty patients who had primary malignant bone tumors underwent a low-heat treated intercalary autograft reconstruction between May 1987 and May 2004. The mean age was 24 years, and the mean follow up was 59.8 months. Osteosynthesis between host bone and low-heat treated autograft was carried out using plates and screws (n=7), rigid IM nails (n=6), plates and flexible IM nails or K-wires (n=4), and rigid IM nail and plate (n=3). Intramedullary cement augmentation was performed in 10 patients but the primary bone graft on the host-graft junction was not performed.
RESULTS
The mean segmental excised bone length was 152 mm. One patient died from acute cardiac arrest unrelated to the tumor but there was no local recurrence and metastasis. Host graft union was achieved in 18 patients after a mean of 8.5 months after surgery. Complications were observed in 7 patients (35%), including 3 fractures, 2 nonunions, and 2 infections. The mean functional outcome was 82% (24.6).
CONCLUSION
A low-heat treated intercalary autograft is a simple, economic and best fitting reconstruction system with a low rate of ultimate failure in carefully selected patients. However, a long term study will be needed to evaluate the graft incorporation and possibility of bone resorption.

Keyword

Malignant bone tumor; Intercalary reconstruction; Low-heat treated autograft; Limb salvage operation

MeSH Terms

Autografts*
Bone Resorption
Diaphyses
Extremities*
Follow-Up Studies
Heart Arrest
Humans
Limb Salvage*
Neoplasm Metastasis
Recurrence
Transplants

Figure

• 

  Fig. 1 (A) Radiograph of 55 year old man with an adamantinoma on tibia. (B) Reconstruction with a 17 cm pasteurized autogaft and osteosynthesis with a rigid IM nail and plate was performed. (C) Union on the junctions appeared sound on the 2 years radiograph. Therefore, we removed the plate first. (D) At 4 years, graft incorporation appeared to be continuing through the entire intercalary graft.

Reference

1. Alman BA, De Bari A, Krajbich JI. Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. J Bone Joint Surg Am. 1995. 77:54–64.

2. Araki N, Myoui A, Kuratsu S, et al. Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res. 1999. 368:196–206.

3. Böhm P, Stihler J. Intraosseous temperature during autoclaving. J Bone Joint Surg Br. 1995. 77:649–653.

4. Cannon SR. Massive prostheses for malignant bone tumours of the limbs. J Bone Joint Surg Br. 1997. 79:497–506.

5. Chen TH, Chen WM, Huang CK. Reconstruction after intercalary resection of malignant bone tumours: comparison between segmental allograft and extracorporeally-irradiated autograft. J Bone Joint Surg Br. 2005. 87:704–709.

6. Ehara S, Nishida J, Shiraishi H, Tamakawa Y. Pasteurized intercalary autogenous bone graft: radiographic and scintigraphic features. Skeletal Radiol. 2000. 29:335–339.

7. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993. 286:241–246.

8. Ewers R, Wangerin K. The autoclaved autogenous reimplant, an immediately replaced, mineral frame. J Maxillofac Surg. 1986. 14:138–142.

9. Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am. 1990. 72:334–345.

10. Gitelis S, Piasecki P. Allograft prosthetic composite arthroplasty for osteosarcoma and other aggressive bone tumors. Clin Orthop Relat Res. 1999. 270:197–201.

11. Glasser DB, Lane JM. Stage IIB osteogenic sarcoma. Clin Orthop Relat Res. 1991. 270:29–39.

12. Han CS, Wood MB, Bishop AT, Cooney WP. Vascularized bone transfer. J Bone Joint Surg Am. 1992. 74:1441–1449.

13. Harrington KD, Johnston JO, Kaufer HN, Luck JV, Moore TM. Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved autogenic grafts. Clin Orthop Relat Res. 1986. 211:180–214.

14. Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990. 72:1477–1485.

15. Izawa H, Hachiya Y, Kawai T, et al. The effect of heat-treated human bone morphogenetic protein on clinical implantation. Clin Orthop Relat Res. 2001. 390:252–258.

16. Leipzig B, Cummings CW. The current status of mandibular reconstruction using autogenous frozen mandibular grafts. Head Neck Surg. 1984. 6:992–997.

17. Liebergall M, Simkin A, Mendelson S, Rosenthal A, Amir G, Segal D. Effect of moderate bone hyperthermia on cell viability and mechanical function. Clin Orthop Relat Res. 1998. 349:242–248.

18. Manabe J. Experimental studies on pasteurized autogenous bone graft. Nippon Seikeigeka Gakkai Zasshi. 1993. 67:225–266.

19. Manabe J, Ahmed AR, Kawaguchi N, Matsumoto S, Kuroda H. Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res. 2004. 419:258–266.

20. Ohta H, Wakitani S, Tensho K, et al. The effects of heat on the biological activity of recombinant human bone morphogenetic protein-2. J Bone Miner Metab. 2005. 23:420–425.

21. Ortiz-Cruz E, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am. 1997. 79:97–106.

22. Rong Y, Sato K, Sugiura H, et al. Effect of elevated temperature on experimental swarm rat chondrosarcoma. Clin Orthop Relat Res. 1995. 311:227–231.

23. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am. 1994. 76:649–656.

24. Sabo D, Brocai DRC, Eble M, Wannenmacher M, Ewerbeck V. Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. Study in a canine model. J Bone Joint Surg Br. 2000. 82:276–282.

25. Springfield D, Schmidt R, Graham-Pole J, Marcus RB, Spanier SS, Enneking WF. Surgical treatment for osteosarcoma. J Bone Joint Surg Am. 1988. 70:1124–1130.

26. Suk KS, Shin KH, Hahn SB. Limb salvage using original low heat-treated tumor-bearing bone. Clin Orthop Relat Res. 2002. 397:385–393.

27. Thompson RC Jr, Pickvance EA, Garry D. Fractures in large-segment allografts. J Bone Joint Surg Am. 1993. 75:1663–1673.

28. Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S. Limb salvage using distraction osteogenesis. A classification of the technique. J Bone Joint Surg Br. 1997. 79:403–411.

29. Tsuchiya H, Wan SL, Sakayama K, Yamamoto N, Nishida H, Tomita K. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg Br. 2005. 87:218–225.

30. Urist MR, DeLange RJ, Finerman GA. Bone cell differentiation and growth factors. Science. 1983. 220:680–686.

31. Urist MR, Iwata H. Preservation and biodegradation of the morphogenetic property of bone matrix. J Theor Biol. 1973. 38:155–167.