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Skeletal Radiology

, Volume 46, Issue 9, pp 1271–1276 | Cite as

Bone adaptation of a biologically reconstructed femur after Ewing sarcoma: Long-term morphological and densitometric evolution

  • Giordano Valente
  • Fulvia Taddei
  • Andrea Roncari
  • Enrico Schileo
  • Marco Manfrini
Case Report

Abstract

Combining bone allografts and vascularized fibular autografts in intercalary reconstructions after resection of bone sarcomas is of particular interest in young patients as it facilitates bone healing and union and helps reduce fractures. However, adverse events related to bone adaptation still occur. Bone adaptation is driven by mechanical loading, but no quantitative biomechanical studies exist that would help surgical planning and rehabilitation. We analyzed the bone adaptation of a successful femoral reconstruction after Ewing sarcoma during 76-month follow-up using a novel methodology that allows CT-based quantification of morphology and density. The results indicated that the vital allograft promoted bone adaptation in the reconstruction. However, an overall negative balance of bone remodeling and a progressive mineral density decrease in the femoral neck might threaten long-term bone safety. These concerns seem related to both surgical technique and mechanical stimuli, where a stiff metal implant may determine load sharing, which negatively affects bone remodeling.

Keywords

Biological reconstruction Bone sarcoma Bone adaptation Biomechanical measurements Bone mineral density 

Notes

Acknowledgements

The authors are grateful to Sabina Piroddi for her contribution to the measurement methodology. This study was supported by the project “Biological bone reconstruction in children skeleton after sarcoma resection. Validation of the technique through CT scan analysis and histological evaluation of the retrieved cases” (RF-2010-2321501), funded by the Italian Ministry of Health, and the National Program of donations to research “5 per mille” 2013.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Kolk S, Cox K, Weerdesteyn V, Hannink G, Bramer J, Dijkstra S, et al. Can orthopedic oncologists predict functional outcome in patients with sarcoma after limb salvage surgery in the lower limb? A nationwide study. Sarcoma. 2014;2014:1–11.CrossRefGoogle Scholar
  2. 2.
    Capanna R, Bufalini C, Campanacci M. A new technique for reconstructions of large metadiaphyseal bone defects. Orthop Traumatol. 1993;3:159–77.CrossRefGoogle Scholar
  3. 3.
    Abed YY, Beltrami G, Campanacci DA, Innocenti M, Scoccianti G, Capanna R. Biological reconstruction after resection of bone tumours around the knee. J Bone Jt Surg Br. 2009;91:1366–72.CrossRefGoogle Scholar
  4. 4.
    Capanna R, Campanacci DA, Belot N, Beltrami G, Manfrini M, Innocenti M, et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am. 2007;38:51–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Houdek MT, Wagner ER, Stans AA, Shin AY, Bishop AT, Sim FH, et al. What is the outcome of allograft and intramedullary free fibula (Capanna technique) in pediatric and adolescent patients with bone tumors? Clin Orthop Relat Res. 2015;474:660–8.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Turner CH. Three rules for bone adaptation to mechanical stimuli. Bone. 1998;23:399–407.CrossRefPubMedGoogle Scholar
  7. 7.
    Ceruso M, Taddei F, Bigazzi P, Manfrini M. Vascularised fibula graft inlaid in a massive bone allograft: considerations on the bio-mechanical behaviour of the combined graft in segmental bone reconstructions after sarcoma resection. Injury. 2008;39:68–74.CrossRefGoogle Scholar
  8. 8.
    Manfrini M, Vanel D, De Paolis M, Malaguti C, Innocenti M, Ceruso M, et al. Imaging of vascularized fibula autograft placed inside a massive allograft in reconstruction of lower limb bone tumors. Am J Roentgenol. 2004;182:963–70.CrossRefGoogle Scholar
  9. 9.
    Kalender WA. A phantom for standarization and quality control in spinal bone mineral measurements by QCT and DXA: design considerations and specifications. Med Phys. 1992;19:583–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage. 2006;31:1116–28.CrossRefPubMedGoogle Scholar
  11. 11.
    Valente G, Pitto L, Testi D, Seth A, Delp SL, Stagni R, et al. Are subject-specific musculoskeletal models robust to the uncertainties in parameter identification? PLoS One. 2014;9:e112625.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schneider CA, Rasband WS, Eliceiri KW. NIH image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9:671–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Ruff CB, Hayes WC. Cross-sectional geometry of Pecos pueblo femora and tibiae—a biomechanical investigation: II. Sex, age, side differences. Am J Phys Anthropol. 1983;60:383–400.CrossRefPubMedGoogle Scholar
  14. 14.
    Noble PC, Box GG, Kamaric E, Fink MJ, Alexander JW, Tullos HS. The effect of aging on the shape of the proximal femur. Clin Orthop Relat Res. 1995;316:31–44.Google Scholar
  15. 15.
    Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Jt Surg Am. 1987;69:1169–76.CrossRefGoogle Scholar
  16. 16.
    Hobusch GM, Noebauer-Huhmann I, Krall C, Holzer G. Do long term survivors of Ewing family of tumors experience low bone mineral density and increased fracture risk? Clin Orthop Relat Res. 2014;472:3471–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Taddei F, Palmadori I, Taylor WR, Heller MO, Bordini B, Toni A, et al. European Society of Biomechanics S.M. Perren award 2014: safety factor of the proximal femur during gait: a population-based finite element study. J Biomech. 2014;47:3433–40.CrossRefPubMedGoogle Scholar
  18. 18.
    Taddei F, Ansaloni M, Testi D, Viceconti M. Virtual palpation of skeletal landmarks with multimodal display interfaces. Med Inf Internet Med. 2007;32:191–8.CrossRefGoogle Scholar
  19. 19.
    Pauchard Y, Fitze T, Browarnik D, Eskandari A, Pauchard I, Enns-Bray W, et al. Interactive graph-cut segmentation for fast creation of finite element models from clinical ct data for hip fracture prediction. Comput Methods Biomech Biomed Engin. 2016;19:1693–703.CrossRefPubMedGoogle Scholar
  20. 20.
    Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech. 2002;35:543–8.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2017

Authors and Affiliations

  • Giordano Valente
    • 1
  • Fulvia Taddei
    • 1
  • Andrea Roncari
    • 1
  • Enrico Schileo
    • 2
  • Marco Manfrini
    • 3
  1. 1.Medical Technology LaboratoryRizzoli Orthopaedic InstituteBolognaItaly
  2. 2.Computational Bioengineering LaboratoryRizzoli Orthopaedic InstituteBolognaItaly
  3. 3.Orthopedic and Traumatologic Clinic for Musculoskeletal TumorsRizzoli Orthopaedic InstituteBolognaItaly

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