Abstract
Purpose
Allograft reconstruction with or without vascularized fibula can be a valuable solution to treat childhood intercalary tumours of the distal femur. We aimed to assess the oncological status, complication rate and survival of distal femur intercalary reconstruction after trans-metaphyseal (TMR) and trans-epiphyseal resection (TER). We also evaluated the impact of distal temporary graft fixation on skeletal growth after TMR.
Methods
We retrospectively reviewed 23 skeletally immature patients affected by distal femur osteosarcoma (18) and Ewing sarcoma (5). Mean patients age was 10.3 years. In 11 cases, TMR was performed with physis preservation and temporary distal graft fixation. In 9 patients, TER was performed with growth plate sacrifice. The last 3 cases were treated with TMR and sliding plate fixation.
Results
Mean follow-up was 8.4 years. No deaths occurred, but 3 patients presented lung metastasis and 2 cases presented local recurrence in soft tissues. 10 implant-related complications occurred, all surgically treated. At skeletal maturity, mean femoral dysmetria was 2.3 cm after TMR and temporary epiphysiodesis, and 3.1 cm after TER. In TMR group, a strong trend towards physeal recovery was observed after epiphyseal screws removal (p = 0.061), but valgus deformity in distal femur was more frequent (p = 0.049). MSTS score was good or excellent in all patients, with no statistically significant difference between TMR and TER.
Conclusions
Intercalary graft reconstruction after TMR and TER allows good local disease control and excellent functional results with long-term follow-up. Temporary distal fixation might reduce the final limb discrepancy after TMR, but valgus deformity could develop.
Level of evidence
Level IV.
Similar content being viewed by others
References
Isakoff MS, Bielack SS, Meltzer P, Gorlick R (2015) Osteosarcoma: current treatment and a collaborative pathway to success. J Clin Oncol 33:3029–3035
Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G (2006) Primary bone osteosarcoma in the pediatric age: state of the art. Cancer Treat Rev 32:423–436
Li X, Zhang Y, Wan S, Li H, Li D, Xia J, Yuan Z, Ren M, Yu S, Li S, Yang Y, Han L, Yang Z (2016) A comparative study between limb-salvage and amputation for treating osteosarcoma. J Bone Oncol 5:15–21
Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ (1994) 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 Jt Surg Ser A 76:649–656
Weber KL (2005) What’s new in musculoskeletal oncology. J Bone Jt Surg Ser A 87:1400–1409
Bertrand TE, Cruz A, Binitie O, Cheong D, Letson GD (2016) Do Surgical margins affect local recurrence and survival in extremity, nonmetastatic, high-grade osteosarcoma? Clin Orthop Relat Res 474:677–683
Bacci G, Forni C, Longhi A, Ferrari S, Mercuri M, Bertoni F, Serra M, Briccoli A, Balladelli A, Picci P (2007) Local recurrence and local control of non-metastatic osteosarcoma of the extremities: a 27-year experience in a single institution. J Surg Oncol 96:118–123
Pritchett JW (1992) Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res 275:274–279
Kang S, Lee JS, Park J, Park SS (2017) Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee. Bone Joint J 99:401–408
Staals EL, Sambri A, Campanacci DA, Muratori F, Leithner A, Gilg MM, Gortzak Y, Van De Sande M, Dierselhuis E, Mascard E, Windhager R, Funovics P, Schinhan M, Vyrva O, Sys G, Bolshakov N, Aston W, Gikas P, Schubert T, Jeys L, Abudu A, Manfrini M, Donati DM (2020) Expandable distal femur megaprosthesis: a European musculoskeletal oncology society study on 299 cases. J Surg Oncol 122:760–765
Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL (2015) Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res 473:1789–1796
Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M (2005) Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Jt Surg Ser A 87:226–236
Houdek MT, Wagner ER, Stans AA, Shin AY, Bishop AT, Sim FH, Moran SL (2016) What is the outcome of allograft and intramedullary free fibula (Capanna technique) in pediatric and adolescent patients with bone tumors? Clin Orthop Relat Res 474:660–668
Shehadeh AM, Isleem U, Abdelal S, Salameh H, Abdelhalim M (2019) Surgical technique and outcome of custom joint-sparing endoprosthesis as a reconstructive modality in juxta-articular bone sarcoma. J Oncol. https://doi.org/10.1155/2019/9417284
Gerrand CH, Rankin K (2014) A system for the surgical staging of musculoskeletal sarcoma. In: Banaszkiewicz P, Kader D (eds) Classic Papers in Orthopaedics, 1st edn. Springer, London, pp 487–488
Henderson ER, O’Connor MI, Ruggieri P, Windhager R, Funovics PT, Gibbons CL, Guo W, Hornicek FJ, Temple HT, Letson GD (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Jt J 96B:1436–1440
Thompson MJ, Shapton JC, Punt SE, Johnson CN, Conrad EU (2018) MRI identification of the osseous extent of pediatric bone sarcomas. Clin Orthop Relat Res 476(3):559–564
Agarwal M, Puri A, Gulia A, Reddy K (2010) Joint-sparing or physeal-sparing diaphyseal resections: the challenge of holding small fragments. Clin Orthop Relat Res 468:2924–2932
Gupta A, Pollock R, Cannon SR, Briggs TWR, Skinner J, Blunn G (2006) A knee-sparing distal femoral endoprosthesis using hydroxyapatite-coated extracortical plates: preliminary results. J Bone Jt Surg Ser B 88:1367–1372
Takeuchi A, Yamamoto N, Hayashi K, Matsubara H, Kimura H, Miwa S, Higuchi T, Abe K, Taniguchi Y, Tsuchiya H (2018) Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord 19:1–10
Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, Yamashiro T, Tomita K (2002) Osteosarcoma around the knee: intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Jt Surg 84:1162–1166
Yu XC, Xu M, Xu SF, Song RX (2012) Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg 4(1):21–27
Mei J, Ni M, Jia GY, Chen YX, Zhu XZ (2015) Intermittent internal fixation with a locking plate to preserve epiphyseal growth function during limb-salvage surgery in a child with osteosarcoma of the distal femur. Medicine 94:1–4
Yoda Y, Yamaguchi SI, Hirozane T, Asano N, Seki A, Morioka H, Nakayama R, Nakamura M, Matsumoto M (2019) Preservation of the epiphysis and growth plate in the surgical management of femoral osteosarcoma in a skeletally immature patient by intercalary resection and biological reconstruction: a case report. Case Rep Oncol 12:513–522
Canadell J, Forriol F, Cara JA (1994) Removal of metaphyseal bone tumours with preservation of the epiphysis. physeal distraction before excision. J Bone Jt Surg Ser B 76:127–132
Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ (2001) Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res 382:87–98
Funding
The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
All authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to declare.
Consent to participate
Written informed consent was obtained from the patients.
Consent for publication
Consent for the study and publication of data from the patients was obtained.
Data availability
The data that support the findings of this study are available from the corresponding author upon request.
Ethical approval
This retrospective study was approved by our Institutional Ethics Committee.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zucchini, R., Staals, E.L., Fiore, M. et al. Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth. Eur J Orthop Surg Traumatol 32, 1651–1659 (2022). https://doi.org/10.1007/s00590-021-03149-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-021-03149-z