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

Han-Soo Kim; Hyun Guy Kang; Jai Ho Cho; Kap Jung Kim; Joo Han Oh; Sang Hoon Lee

doi:10.4055/jkoa.2007.42.3.291

Journal List > J Korean Orthop Assoc > v.42(3) > 1012654

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Kim, Kang, Cho, Kim, Oh, and Lee: Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(3): 291-297.

Published online: 30 June 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.3.291

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

Han-Soo Kim, M.D., Hyun Guy Kang, M.D., Jai Ho Cho, M.D., Kap Jung Kim, M.D., Joo Han Oh, M.D., Sang Hoon Lee, M.D.

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Address reprint requests to Han-Soo Kim, M.D. Department of Orthopaedic Surgery, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: +82.2-2072-2362, Fax: +82.2-764-2718, hik19@snu.ac.kr

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.

Keywords: Malignant bone tumor, Intercalary reconstruction, Low-heat treated autograft, Limb salvage operation

Figures and Tables

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.

Table 1

Details of the Patients Who had a Reconstruction with a Pasteurized Intercalary Autograft

MFH, malignant fibrous histiocytoma; C, cement; P, plate; FIM, flexible intramedullary nail; RIM, rigid intramedullary nail; K, k-wire; CDF, continuous disease free.

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