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European Journal of Orthopaedic Surgery & Traumatology

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21-10-2021 | osteosarcoma | Original Article

Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth

Authors: Riccardo Zucchini, Eric Lodewijk Staals, Michele Fiore, Laura Campanacci, Claudio Giannini, Marco Manfrini, Davide Maria Donati

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2022

Abstract

Purpose

Allograft reconstruction with or without vascularized fibula can be a valuable solution to treat childhood intercalary tumours of the distal femur. We aimed to assess the oncological status, complication rate and survival of distal femur intercalary reconstruction after trans-metaphyseal (TMR) and trans-epiphyseal resection (TER). We also evaluated the impact of distal temporary graft fixation on skeletal growth after TMR.

Methods

We retrospectively reviewed 23 skeletally immature patients affected by distal femur osteosarcoma (18) and Ewing sarcoma (5). Mean patients age was 10.3 years. In 11 cases, TMR was performed with physis preservation and temporary distal graft fixation. In 9 patients, TER was performed with growth plate sacrifice. The last 3 cases were treated with TMR and sliding plate fixation.

Results

Mean follow-up was 8.4 years. No deaths occurred, but 3 patients presented lung metastasis and 2 cases presented local recurrence in soft tissues. 10 implant-related complications occurred, all surgically treated. At skeletal maturity, mean femoral dysmetria was 2.3 cm after TMR and temporary epiphysiodesis, and 3.1 cm after TER. In TMR group, a strong trend towards physeal recovery was observed after epiphyseal screws removal (p = 0.061), but valgus deformity in distal femur was more frequent (p = 0.049). MSTS score was good or excellent in all patients, with no statistically significant difference between TMR and TER.

Conclusions

Intercalary graft reconstruction after TMR and TER allows good local disease control and excellent functional results with long-term follow-up. Temporary distal fixation might reduce the final limb discrepancy after TMR, but valgus deformity could develop.

Level of evidence

Level IV.

Isakoff MS, Bielack SS, Meltzer P, Gorlick R (2015) Osteosarcoma: current treatment and a collaborative pathway to success. J Clin Oncol 33:3029–3035CrossRef

Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G (2006) Primary bone osteosarcoma in the pediatric age: state of the art. Cancer Treat Rev 32:423–436CrossRef

Li X, Zhang Y, Wan S, Li H, Li D, Xia J, Yuan Z, Ren M, Yu S, Li S, Yang Y, Han L, Yang Z (2016) A comparative study between limb-salvage and amputation for treating osteosarcoma. J Bone Oncol 5:15–21CrossRef

Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ (1994) Limb salvage compared with amputation for osteosarcoma of the distal end of the femur: a long-term oncological functional, and quality-of-life study. J Bone Jt Surg Ser A 76:649–656CrossRef

Weber KL (2005) What’s new in musculoskeletal oncology. J Bone Jt Surg Ser A 87:1400–1409

Bertrand TE, Cruz A, Binitie O, Cheong D, Letson GD (2016) Do Surgical margins affect local recurrence and survival in extremity, nonmetastatic, high-grade osteosarcoma? Clin Orthop Relat Res 474:677–683CrossRef

Bacci G, Forni C, Longhi A, Ferrari S, Mercuri M, Bertoni F, Serra M, Briccoli A, Balladelli A, Picci P (2007) Local recurrence and local control of non-metastatic osteosarcoma of the extremities: a 27-year experience in a single institution. J Surg Oncol 96:118–123CrossRef

Pritchett JW (1992) Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res 275:274–279CrossRef

Kang S, Lee JS, Park J, Park SS (2017) Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee. Bone Joint J 99:401–408CrossRef

10.

Staals EL, Sambri A, Campanacci DA, Muratori F, Leithner A, Gilg MM, Gortzak Y, Van De Sande M, Dierselhuis E, Mascard E, Windhager R, Funovics P, Schinhan M, Vyrva O, Sys G, Bolshakov N, Aston W, Gikas P, Schubert T, Jeys L, Abudu A, Manfrini M, Donati DM (2020) Expandable distal femur megaprosthesis: a European musculoskeletal oncology society study on 299 cases. J Surg Oncol 122:760–765CrossRef

11.

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 473:1789–1796CrossRef

12.

Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M (2005) Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Jt Surg Ser A 87:226–236

13.

Houdek MT, Wagner ER, Stans AA, Shin AY, Bishop AT, Sim FH, Moran SL (2016) What is the outcome of allograft and intramedullary free fibula (Capanna technique) in pediatric and adolescent patients with bone tumors? Clin Orthop Relat Res 474:660–668CrossRef

14.

Shehadeh AM, Isleem U, Abdelal S, Salameh H, Abdelhalim M (2019) Surgical technique and outcome of custom joint-sparing endoprosthesis as a reconstructive modality in juxta-articular bone sarcoma. J Oncol. https://doi.org/10.1155/2019/9417284CrossRefPubMedPubMedCentral

15.

Gerrand CH, Rankin K (2014) A system for the surgical staging of musculoskeletal sarcoma. In: Banaszkiewicz P, Kader D (eds) Classic Papers in Orthopaedics, 1st edn. Springer, London, pp 487–488CrossRef

16.

Henderson ER, O’Connor MI, Ruggieri P, Windhager R, Funovics PT, Gibbons CL, Guo W, Hornicek FJ, Temple HT, Letson GD (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Jt J 96B:1436–1440CrossRef

17.

Thompson MJ, Shapton JC, Punt SE, Johnson CN, Conrad EU (2018) MRI identification of the osseous extent of pediatric bone sarcomas. Clin Orthop Relat Res 476(3):559–564CrossRef

18.

Agarwal M, Puri A, Gulia A, Reddy K (2010) Joint-sparing or physeal-sparing diaphyseal resections: the challenge of holding small fragments. Clin Orthop Relat Res 468:2924–2932CrossRef

19.

Gupta A, Pollock R, Cannon SR, Briggs TWR, Skinner J, Blunn G (2006) A knee-sparing distal femoral endoprosthesis using hydroxyapatite-coated extracortical plates: preliminary results. J Bone Jt Surg Ser B 88:1367–1372CrossRef

20.

Takeuchi A, Yamamoto N, Hayashi K, Matsubara H, Kimura H, Miwa S, Higuchi T, Abe K, Taniguchi Y, Tsuchiya H (2018) Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord 19:1–10CrossRef

21.

Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, Yamashiro T, Tomita K (2002) Osteosarcoma around the knee: intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Jt Surg 84:1162–1166CrossRef

22.

Yu XC, Xu M, Xu SF, Song RX (2012) Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg 4(1):21–27CrossRef

23.

Mei J, Ni M, Jia GY, Chen YX, Zhu XZ (2015) Intermittent internal fixation with a locking plate to preserve epiphyseal growth function during limb-salvage surgery in a child with osteosarcoma of the distal femur. Medicine 94:1–4CrossRef

24.

Yoda Y, Yamaguchi SI, Hirozane T, Asano N, Seki A, Morioka H, Nakayama R, Nakamura M, Matsumoto M (2019) Preservation of the epiphysis and growth plate in the surgical management of femoral osteosarcoma in a skeletally immature patient by intercalary resection and biological reconstruction: a case report. Case Rep Oncol 12:513–522CrossRef

25.

Canadell J, Forriol F, Cara JA (1994) Removal of metaphyseal bone tumours with preservation of the epiphysis. physeal distraction before excision. J Bone Jt Surg Ser B 76:127–132CrossRef

26.

Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ (2001) Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res 382:87–98CrossRef

Title: Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth
Authors: Riccardo Zucchini
Eric Lodewijk Staals
Michele Fiore
Laura Campanacci
Claudio Giannini
Marco Manfrini
Davide Maria Donati
Publication date: 21-10-2021
Publisher: Springer Paris
Keywords: osteosarcoma
Osteosarcoma
Sarcoma
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2022
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-021-03149-z

ERS Congress 2024

Springer Medicine

Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

ERS Congress 2024

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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