THE USE OF IRRADIATED AUTOLOGOUS BONE IN JOINT SPARING ENDOPROSTHETIC REPLACEMENT TUMOUR SURGERY

Abstract

The use of massive endoprostheses following bone tumour resection is well recognised. Where possible, joint salvage rather than joint replacement is usually attempted. However cases arise where there may be insufficient bone stock following tumour resection to allow fixation of a joint sparing prosthesis. We report a series of 4 patients (age4–12) treated between 1994 and 2008, in which irradiated autologous bone has been combined with a diaphyseal or distal femoral replacement in order to preserve the native hip joint. There were 3 cases of osteosarcoma and 1 cases of Ewings sarcoma. After a mean follow up of 53 months (range 9–168) all patients had survived without evidence of local recurrence or metastases. One implant was revised after 14 years following fracture of the extending component of the growing endoprosthesis. There have been no cases of loosening or peri-prosthetic fracture. This is the first report of irradiated autologous bone with joint sparing endoprostheses in the skeletally immature patient.

Introduction: Reconstruction of segmental skeletal defects after malignant bone tumour removal has been a topic of much debate. Autoclaved or irradiated autologous bone used in the treatment of malignant bone tumours of the proximal femur in skeletally mature patients has been well reported with a high incidence of fracture and non-union. On follow up, our series of skeletally immature patients showed excellent osteo-integration with native bone and allowed preservation of the native hip joint.

Results: We review survival of the patient, implant, any complication and the presence of disease progression.