Abstract
Aims
We report a series of patients treated with intercalary bone graft (IBG) of the tibia diaphysis (TD) after resection of primary bone tumors. The purpose of this study was to evaluate the mid- and long-term survival of TD IBG reconstruction in children and adults, characterizing patterns of success and failure.
Methods
A total of 35 patients were included in this retrospective study. Median age was 22 years (range, 8–57). This series included 19 patients (54.3%) treated with homologous bone graft alone and 16 patients (45.7%) treated combining intercalary allograft with fibular autograft. Complications were recorded according to Henderson classification.
Results
Median follow-up was 36 months (range, 1–165). Local recurrence occurred in 2 patients (5.7%) after 12 and 60 months, respectively. Major complications included graft fracture (9 cases), non-union (5 cases) and infection (4 cases). Other complications were axial deformity (2 cases), superficial infection (2 cases), compartmental syndrome (1 case).
Conclusion
Intercalary bone grafts of TD have been recommended as a reliable solution with long-term success rates and good functional outcome in more than 80% of patients. However, approximately half of the patients may require further surgeries to treat major complications (deep infection, delayed or non-union and graft fracture). Additional vascularized fibula graft may ameliorate final result.
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Change history
10 July 2020
The original version of this article unfortunately contained a mistake. The spelling of the name ‘Valerio Bochicchio’ was incorrect.
References
Ramseier LE, Malinin TI, Temple HT et al (2006) Allograft reconstruction for bone sarcoma of the tibia in the growing child. J Bone Jt Surg Br Vol 88:95–99. https://doi.org/10.1302/0301-620X.88B1.16253
Muscolo DL, Ayerza MA, Aponte-Tinao L et al (2004) Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000141652.93178.10
Bus MPA, Dijkstra PDS, van de Sande MAJ et al (2014) Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Jt Surg Am 96:e26. https://doi.org/10.2106/JBJS.M.00655
Farfalli GL, Aponte-Tinao L, Lopez-Millan L et al (2012) Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics 35:e391–e396. https://doi.org/10.3928/01477447-20120222-25
Errani C, Ceruso M, Donati DM, Manfrini M (2019) Microsurgical reconstruction with vascularized fibula and massive bone allograft for bone tumors. Eur J Orthop Surg Traumatol 29:307–311. https://doi.org/10.1007/s00590-018-2360-2
Ng VY, Louie P, Punt S, Conrad EU (2017) Allograft reconstruction for sarcomas of the tibia. Open Orthop J 11:189–194. https://doi.org/10.2174/1874325001711010189
Babhulkar S, Pande K, Babhulkar S (2005) Nonunion of the diaphysis of long bones. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000152369.99312.c5
Sanders PTJ, Spierings JF, Albergo JI et al (2020) Long-term clinical outcomes of intercalary allograft reconstruction for lower-extremity bone tumors. J Bone Jt Surg Am. https://doi.org/10.2106/JBJS.18.00893
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. https://doi.org/10.1007/s11999-014-4028-5
Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL (2015) Should fractures in massive intercalary bone allografts of the lower limb be treated with ORIF or with a new allograft? Clin Orthop Relat Res 473:805–811. https://doi.org/10.1007/s11999-014-3659-x
Aponte-Tinao LA, Ayerza MA, Albergo JI, Farfalli GL (2020) Do massive allograft reconstructions for tumors of the femur and tibia survive 10 or more years after implantation? Clin Orthop Relat Res 478:517–524. https://doi.org/10.1097/corr.0000000000000806
Aponte-Tinao LA, Albergo JI, Ayerza MA et al (2018) What are the complications of allograft reconstructions for sarcoma resection in children younger than 10 years at long-term followup? Clin Orthop Relat Res 476:548–555. https://doi.org/10.1007/s11999.0000000000000055
Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL (2016) What are the risk factors and management options for infection after reconstruction with massive bone allografts? Clin Orthop Relat Res 474:669–673. https://doi.org/10.1007/s11999-015-4353-3
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120
Abolhasan B, Khalil N, Hadi Y (2006) Complications of massive allograft reconstruction for bone tumors. J Res Med Sci 11:240–247
Henderson ER, O’Connor MI, Ruggieri P et al (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system Including biological and expandable reconstructions. Bone Jt J 96-B:1436–1440. https://doi.org/10.1302/0301-620X.96B11.34747
Frisoni T, Cevolani L, Giorgini A et al (2012) Factors affecting outcome of massive intercalary bone allografts in the treatment of tumours of the femur. J Bone Jt Surg Br Vol 94:836–841. https://doi.org/10.1302/0301-620X.94B6.28680
Mohler DG, Yaszay B, Hong R, Wera G (2003) Intercalary tibial allografts following tumor resection: the role of fibular centralization. Orthopedics 26:631–637
Rabitsch K, Maurer-Ertl W, Pirker-Fruhauf U et al (2013) Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma 2013:160295. https://doi.org/10.1155/2013/160295
Brien EW, Terek RM, Healey JH, Lane JM (1994) Allograft reconstruction after proximal tibial resection for bone tumors. An analysis of function and outcome comparing allograft and prosthetic reconstructions. Clin Orthop Relat Res 303:116–127
Thompson RCJ, Pickvance EA, Garry D (1993) Fractures in large-segment allografts. J Bone Jt Surg Am 75:1663–1673. https://doi.org/10.2106/00004623-199311000-00011
Sorger JI, Hornicek FJ, Zavatta M et al (2001) Allograft fractures revisited. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200101000-00011
Dick HM, Strauch RJ (1994) Infection of massive bone allografts. Clin Orthop Relat Res 306:46–53
Brunet O, Anract P, Bouabid S et al (2011) Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases. Orthop Traumatol Surg Res 97:512–519. https://doi.org/10.1016/j.otsr.2011.03.021
Ortiz-Cruz E, Gebhardt MC, Jennings LC et al (1997) The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am 79:97–106. https://doi.org/10.2106/00004623-199701000-00010
Hornicek FJ, Gebhardt MC, Tomford WW et al (2001) Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200101000-00014
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Giannini, C., Sambri, A., Dalla Rosa, M. et al. Intercalary bone graft of the tibia: case series and review of the literature. Eur J Orthop Surg Traumatol 30, 1421–1427 (2020). https://doi.org/10.1007/s00590-020-02718-y
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DOI: https://doi.org/10.1007/s00590-020-02718-y