Evaluation of the Efficacy of Pasteurized Autograft and Intramedullary Vascularized Fibular Transfer for Osteosarcoma of the Femoral Diaphysis

Abstract

Objective: To assess the treatment of osteosarcomas of the femoral diaphysis through wide en bloc excision and reconstruction of the defect by pasteurized autograft combined with vascularized fibular transfer.

Methods: A single-center, retrospective study was performed of 15 selected patients (six females, nine males) whose lesion in the middle diaphysis of the femur were treated by en bloc excision and reconstruction of the bone defect with recycled pasteurized autograft combined with vascularized fibular graft between January 2000 and December 2011. The primary diagnoses of the patients were osteosarcoma (15 patients), and one of these patients had a pathological fracture. The mean patient age at the time of surgery was 22.3 years (range, 10-40 years). All these cases of bone tumors were staged according to Enneking's criteria with three stage IIA cases, and 12 stage IIB cases. The patients were examined clinically and radiologically every month during the first 6 months after surgery to exclude the evidence of infection and local recurrence, then at 3-monthly intervals for 2 years and then at 6-monthly intervals for life. Function was assessed using the Musculoskeletal Tumor Society Scoring system (MSTS).

Results: At a mean follow-up of 65.1 months (range, 31-131 months), all the patients had achieved bony union at the final follow-up. The mean time to bone union of the proximal junctions of vascularized fibula was 8.7 months (range, 6.0-13.0 months) and that of the distal junctions was 9.2 months (range, 6.0-12.0 months). Mean union time of the proximal junctions of the pasteurized autogenous bone was 14.3 months (range, 10.0-25.0 months) and that of the distal junctions was 15.6 months (range, 10.0-27.0 months). There were two fractures of the pasteurized bone during the operation. One patient, in whom the plate had been removed after union at 3 years postoperatively, sustained a fracture in a fall. This was treated with external fixation and united uneventfully. One patient, in whom two of the proximal screws had been broken, developed coxa vara. There was no infection. There were three pulmonary metastases and no local recurrence. The mean function score was 81.8%. Five patients died of their underlying disease, and the disease-specific survival of patients was 69.1%.

Conclusions: Pasteurized autogenous bone graft combined with a vascularized fibula graft is a useful reconstruction method for large bone defects after resection of osteosarcoma in the femur.

Keywords: Autografts; Femur; Limb Salvage; Osteosarcoma; diaphyses.