Long-term Results of Osteoarticular Allograft Reconstruction in Children with Distal Femoral Bone Tumors

Document Type : RESEARCH PAPER

Authors

Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: There is no consensus regarding the best method of reconstruction in pediatric population following the
wide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads to
less existing controversy of this type of reconstruction, which is the main point of this article.
Methods: Long-term outcomes and complications of osteoarticular allograft reconstruction of primary distal femoral bone
sarcomas in 22 children with mean age of 10.7 years old were reviewed in this study. Musculoskeletal Tumor Society
(MSTS) scoring system was used for functional evaluation of the allografts.
Results: With an average follow-up time of 81 months, the outcomes of 16 patients with allografts at the final follow up
were evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), which
was significantly correlated to allograft survival time (P<0.001). Degenerative joint disease (DJD) was also seen in all
patients and its grade was also significantly correlated to allograft survival time (P<0.001). The mean MSTS-score was
74% at the latest follow-up, ranging from 60% to 90%. Five and 10 year survival rate of allografts were found to be 93.3%
and 62.2%, respectively.
Conclusion: Osteoarticular allograft reconstruction could result in several complications including DJD. Despite its
considerable biologic advantage over endoprosthesis, osteoarticular allograft reconstruction is a long-lasting but still a
temporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for limb
growth and become old enough for an adult megaprosthesis.

Keywords

Main Subjects

References

1. Bloem JL, Taminiau AH, Eulderink F, Hermans J,
Pauwels EK. Radiologic staging of primary bone
sarcoma: MR imaging, scintigraphy, angiography,
and CT correlated with pathologic examination.
Radiology. 1988; 169(3):805-10.
2. Enneking WF. An abbreviated history of orthopaedic
oncology in North America. Clin Orthop Relat Res.
2000; 374:115-24.
3. Ottaviani G, Jaffe N. The epidemiology of
osteosarcoma. Pediatric and adolescent
osteosarcoma. New York: Springer; 2009. P. 3-13.
4. Chauhan A, Joshi GR, Chopra BK, Ganguly M,
Reddy GR. Limb salvage surgery in bone tumors: a
retrospective study of 50 cases in a single center.
Indian J Surg Oncol. 2013; 4(3):248-54.
5. Orlic D, Smerdelj M, Kolundzic R, Bergovec M. Lower
limb salvage surgery: modular endoprosthesis
in bone tumour treatment. Int Orthop. 2006;
30(6):458-64.
6. Cipriano CA, Gruzinova IS, Frank RM, Gitelis S, Virkus
WW. Frequent complications and severe bone loss
associated with the Repiphysis expandable distal
femoral prosthesis. Clin Orthop Relat Res. 2015;
473(3):831-8.
7. Ruggieri P, Mavrogenis AF, Pala E, Romantini M,
Manfrini M, Mercuri M. Outcome of expandable
prostheses in children. J Pediatr Orthop. 2013;
33(3):244-53.
8. Saghieh S, Abboud MR, Muwakkit SA, Saab R, Rao B,
Haidar R. Seven‐year experience of using Repiphysis
expandable prosthesis in children with bone tumors.
Pediatr Blood Cancer. 2010; 55(3):457-63.
9. Alman BA, De Bari A, Krajbich JI. Massive allografts in
the treatment of osteosarcoma and Ewing sarcoma
in children and adolescents. J Bone Joint Surg Am.
1995; 77(1):54-64.
10. Mnaymneh W, Malinin TI, Lackman RD, Hornicek
FJ, Ghandur-Mnaymneh L. Massive distal femoral
osteoarticular allografts after resection of bone
tumors. Clin Orthop Relat Res. 1994; 303:103-15.
11. Muscolo DL, Ayerza MA, Aponte-Tinao L, Farfalli G.
Allograft reconstruction after sarcoma resection
in children younger than 10 years old. Clin Orthop
Relat Res. 2008; 466(8):1856-62.
12. Campanacci L, Manfrini M, Colangeli M, Alì􀆰 N, Mercuri
M. Long-term results in children with massive bone
osteoarticular allografts of the knee for high-grade
osteosarcoma. J Pediatr Orthop. 2010; 30(8):919-27.
13. Exner U. Allograft reconstruction for malignant bone
tumors in the growing child. J Bone Joint Surg Br.
2003; 85(SUPP III):261.
14. Frederick L, Page DL, Fleming ID, Fritz AG, Balch CM,
Haller DG, et al. AJCC cancer staging manual. Berlin,
Germany: Springer Science & Business Media; 2002.
15. Demetri GD, Pollock R, Baker L, Balcerzak S, Casper
E, Conrad C, et al. NCCN sarcoma practice guidelines.
National Comprehensive Cancer Network. Oncology
(Williston Park, NY). 1998; 12(7A):183-218.
16. Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann
W. Intramedullary, antibiotic-loaded cemented,
massive allografts for skeletal reconstruction. 26
cases compared with 19 uncemented allografts. Acta
Orthop Scand. 1997; 68(4):387-91.
17. Enneking WF, Dunham W, Gebhardt MC, Malawar M,
Pritchard DJ. A system for the functional evaluation
of reconstructive procedures after surgical
treatment of tumors of the musculoskeletal system.
Clin Orthop Relat Res. 1993; 286(25):241-6.
18. Mankin HJ, Gebhardt MC, Jennings LC, Springfield
DS, Tomford WW. Long-term results of allograft
replacement in the management of bone tumors.
Clin Orthop Relat Res. 1996; 324:86-97.
19. Fitch FR, Doolan PT, Dwyer J, Dwyer V, Halls NA,
Tallentire A. Towards microbiological quality
assurance in radiation sterilization processing:
simulation of the radiation inactivation process. J
Appl Bacteriol. 1985; 58(3):307-13.
20. Anderson M, Green WT, Messner MB. Growth and
predictions of growth in the lower extremities. J
Bone Joint Surg Am. 1963; 45(1):1-14.
The Archives of Bone and Joint Surgery
Volume 5, Issue 5
September 2017
Pages 296-301

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History

  • Receive Date: 17 May 2016
  • Revise Date: 13 August 2016
  • Accept Date: 16 August 2016

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