Sliding bone graft at the distal femur after wide resection for malignant tumor

Abstract

Objective

Wide resection of a tumor of the distal femur in healthy tissue while sparing the knee joint and preserving function of the limb.

Indications

Tumors of the distal femur on the conditions that the distal epiphysis can be preserved for stable anchorage of a condylar blade plate, that limb-sparing surgery is possible and that tumor therapy is curative (expected survival time at least 5 years).

Contraindications

Large defects which cannot be bridged by a sliding graft.

No possibility for stable anchorage with the condylar blade plate.

Generalized tumor disease.

Local infections.

Surgical Technique

Wide tumor resection through a posterolateral approach. Reconstruction of the defect with a proximal femoral sliding graft, free contralateral fibular transplant and autogenous iliac bone graft. Stabilization of the fragments with screws and a long condylar blade plate.

Results

A 20-year-old woman with an osteoblastic osteosarcoma and a 15-year-old boy with a low-grade chondrosarcoma were treated with this technique. In none of the patients a local recurrence or metastasis was observed 9 and 7 years, respectively, after tumor resection. Full weight bearing could be resumed at 6 weeks in the first and at 12 weeks in the second patient. At the latest follow-up, both patients had good to excellent functional results.