Abstract
Background
The aim of this study was to investigate the long-term functional capabilities of patients who underwent bone distraction for the treatment of bone defects caused by bone tumor excision.
Methods
Bone distraction was indicated for patients with stage IIB malignant bone tumors when chemotherapy was judged to be effective and an epiphysis could be preserved or for patients with low-grade or aggressive benign bone tumors. Twenty-two patients who underwent reconstruction with bone distraction and were followed up for at least 10 years were retrospectively investigated. Patients included 8 males and 14 females, with a mean age of 25.3 years. Tumor types included seven osteosarcomas, two osteofibrous dysplasias, one Ewing’s sarcoma, five low-grade osteosarcomas, two adamantinomas, and five giant cell tumors. Chemotherapy was performed during bone distraction in 8 cases. Bone transport was used in 17 cases, while shortening distraction was used in 5 cases.
Results
The mean distraction length was 8.1 cm, and the mean external fixation period was 301 days. The average Musculoskeletal Tumor Society score (used to measure functional outcome) was 91.5 % at mean follow-up of 202 months. Fourteen patients were able to play sports without any difficulty.
Conclusions
Epiphyseal preservation and reconstruction by bone distraction require both time and effort, but can provide excellent long-term outcomes, resulting in a stable reconstruction that functionally restores the natural limb.
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References
Messerschmitt PJ, Garcia RM, Abdul-Karim FW, Greenfield EM, Getty PJ. Osteosarcoma. J Am Acad Orthop Surg. 2009;17:515–27.
Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol. 2005;6:85–92.
Heare T, Hensley MA, Dell’Orfano S. Bone tumors: osteosarcoma and Ewing’s sarcoma. Curr Opin Pediatr. 2009;21:365–72.
Ottaviani G, Robert RS, Huh WW, Jaffe N. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage. Cancer Treat Res. 2010;152:421–36.
Jeys LM, Grimmer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop. 2003;27:160–3.
Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am. 2006;88-A:1285–93.
Asada N, Tsuchiya H, Kitaoka K, Mori Y, Tomita K. Massive autoclaved allografts and autografts for limb salvage surgery. A 1–8 year follow-up of 23 patients. Acta Orthop Scand. 1997;68:392–5.
Hayashi K, Tsuchiya H, Yamamoto N, Minato H, Tomita K. Histological examination of autoclaved bone removed 12 years after it was transplanted. J Orthop Sci. 2005;10:425–9.
Rödl RW, Ozaki T, Hoffmann C, Böttner F, Lindner N, Winkelmann W. Osteoarticular allograft in surgery for highgrade malignant tumors of bone. J Bone Joint Surg Br. 2000;82:1006–10.
Abed YY, Beltrami G, Campanacci DA, Innocenti M, Scoccianti G, Capanna R. Biological reconstruction after resection of bone tumors around the knee: long-term follow-up. J Bone Joint Surg Br. 2009;91:1366–72.
Tsuchiya H, Tomita K, Mori Y, Asada N, Morinaga T, Kitano S, Yamamoto N. Caffeine-assisted chemotherapy and minimized tumor excision for nonmetastatic osteosarcoma. Anticancer Res. 1998;18:657–66.
Tsuchiya H, Tomita K, Mori Y, Asada N, Yamamoto N. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop. 1999;358:27–35.
Tsuchiya H, Abdel-Wanis ME, Kitano S, Sakurakichi K, Yamashiro T, Tomita K. The natural limb is best: joint preservation and reconstruction by distraction osteogenesis for high-grade juxta-articular osteosarcomas. Anticancer Res. 2002;22:2373–6.
Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, Yamashiro T, Tomita K. Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg Br. 2002;84:1162–6.
Tsuchiya H, Tomita K. Distraction osteogenesis for treatment of bone loss in the lower extremity. J Orthop Sci. 2003;8:116–24.
Tsuchiya H, Abdel-Wanis ME, Tomita K. Biological reconstruction after excision of juxta-articular osteosarcoma around the knee: a new classification system. Anticancer Res. 2006;26:447–53.
Tsuchiya H, Morsy AF, Matsubara H, Watanabe K, Abdel-Wanis ME, Tomita K. Treatment of benign bone tumors using external fixation. J Bone Joint Surg Br. 2007;89:1077–83.
Hayashi K, Tsuchiya H, Yamamoto N, Takeuchi A, Tomita K. Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery. Int Orthop. 2008;32:63–8.
Tsuchiya H, Yasutake H, Yokogawa A, Baba H, Ueda Y, Tomita K. Effect of chemotherapy combined with caffeine for osteosarcoma. J Cancer Res Clin Oncol. 1992;118:567–9.
Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop. 1993;286:241–6.
Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop. 1990;250:81–104.
Bacci G, Ferrari S, Lari S, Mercuri M, Donati D, Longhi A, Forni C, Bertoni F, Versari M, Pignotti E. Osteosarcoma of the limb. Amputation or limb salvage in patients treated by neoadjuvant chemotherapy. J Bone Joint Surg Br. 2000;84:88–92.
Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S. Limb salvage using distraction osteogenesis: a classification of the technique. J Bone Joint Surg Br. 1997;79:403–11.
Plotz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop. 2002;405:207–15.
Jeon DG, Kawai A, Boland P, Healy JH. Algorithm for the surgical treatment of malignant lesions of the proximal tibia. Clin Orthop. 1999;358:15–26.
Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of a malignant tumor of the distal femur: medium to long-term results. J Bone Joint Surg Am. 1998;80:636–47.
Aho AJ, Ekfors T, Dean PB, Aro HT, Ahonen A, Nikkanen V. Incorporation and clinical results of large allografts of the extremities and pelvis. Clin Orthop. 1994;307:200–13.
Ortiz-Cruz E, Gebhardt MC, Jennings L, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts after resection of tumors: a long-term follow-up study. J Bone Joint Surg Am. 1997;79:97–106.
Hornicek FJ Jr, Mnaymneh W, Lackman RD, Exner GU, Malinin TI. Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors. Clin Orthop. 1998;352:179–86.
Thompson RC Jr, Garg A, Clohisy DR, Cheng EY. Fractures in large-segment allografts. Clin Orthop. 2000;370:227–35.
Tsuchiya H, Tomita K, Shinokawa Minematsu K, Katsuo S, Taki J. The Ilizarov method in the management of giant-cell tumors of the proximal tibia. J Bone Joint Surg Br. 1996;78:264–9.
Kumta SM, Chow TC, Griffith J. Classifying the location of osteosarcoma with reference to the epiphyseal plate helps determine the optimal skeletal resection in limb salvage procedures. Arch Orthop Trauma Surg. 1999;119:327–31.
Manfrini M, Gasbarrini A, Malaguti C, Ceruso M, Innocenti M, Bini S, Capanna R, Campanacci M. Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop. 1999;358:111–9.
Tsuchiya H, Shirai T, Morsy AF, Sakayama K, Wada T, Kusuzaki K, Sugita T, Tomita K. Safety of external fixation during postoperative chemotherapy. J Bone Joint Surg Br. 2008;90:924–8.
Minematsu K, Tsuchiya H, Taki J, Tomita K. Blood flow measurement during distraction osteogenesis. Clin Orthop. 1998;347:229–35.
Shirai T, Tsuchiya H, Yamamoto N, Sakurakichi K, Karita M, Tomita K. Successful management of complications from distraction osteogenesis after osteosarcoma resection: a case report. J Orthop Sci. 2004;9:638–42.
Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ. Factors affecting nonunion of the allograft-host junction. Clin Orthop. 2001;382:87–98.
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Watanabe, K., Tsuchiya, H., Yamamoto, N. et al. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci 18, 101–109 (2013). https://doi.org/10.1007/s00776-012-0327-4
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DOI: https://doi.org/10.1007/s00776-012-0327-4