We have treated 50 patients with bony malignancy by en bloc resection, extracorporeal irradiation (ECI) with 50Gy and re-implantation of the bone segment as a method of limb salvage. Mean survivor follow-up is 38 months (12–92). 42 patients remain alive without disease. 4 recurrences occurred. Functional results were generally good: Mankin grades 17 excellent, 13 good, 9 fair, 3 failures; MSTS mean 77 (20–100); TESS mean 81 (40–100). Solid bony union was the norm, however bone resorption was seen in some cases. The dose of radiation is theoretically lethal to all cells and produces a dead autogenous bone graft of perfect fit. ECI is a useful technique of limb salvage where there is a reasonable residual bone stock. It allows effective re-attachment of muscle tendons, and produces a lasting biological reconstruction. The risk from the re-implanted bone of both local recurrence and of late radiotherapy induced malignancy should be nil.

Aim. To identify factors leading to the success or failure of extracorporeal irradiation and re-implantation of bone (ECIR). Method. Review of experience of this technique since 1996 documenting successes and failures. Results. 35 patients with a variety of malignant bone tumours underwent ECIR from 1996 up to 2007. The most common diagnosis was Ewings' sarcoma (15) followed by osteosarcoma (9) and chondrosarcoma (5) with the most common sites being the pelvis (15) followed by the tibia (10) and humerus (3). The age range was from 7 to 66 and 8 were skeletally immature at the time of surgery. The bones were sterilised with a dose of 90Gy before reimplantation. The overall patient survival was 69% at 5 years and 62% at 10 years. Local recurrence arose in 4 cases, 3 of whom already had metastatic disease. None of the LR arose in the irradiated bone. The rate of non union was 9% at the 58 osteotomies, the greatest risk being in the tibia. There were four graft fractures of which 3 needed fixation and all united. There is one case of convincing graft resorbtion after 12 years. Two patients developed infections but there have been none since the bone was routinely immersed in antibiotics whilst being irradiated. Conclusion. ECIR is a useful technique with very limited indications. In the majority of cases it works well. It appears particularly useful in pelvic resections and diaphyseal resections. Distal tibial reconstructions do worst. The irradiated bone needs reinforcing with either cement or a bone graft for best results

Aim: To identify factors leading to the success or failure of extracorporeal irradiation and reimplantation of bone (ECIR). Method: Review of experience of this technique since 1996 documenting successes and failures. Results: 35 patients with a variety of malignant bone tumours underwent ECIR from 1996 up to 2007. The most common diagnosis was Ewings’ sarcoma (15) followed by osteosarcoma (9) and chondrosarcoma (5) with the most common sites being the pelvis (15) followed by the tibia (10) and humerus (3). The age range was from 7 to 66 and 8 were skeletally immature at the time of surgery. The bones were sterilised with a dose of 90Gy before reimplantation. The overall patient survival was 69% at 5 years and 62% at 10 years. Local recurrence arose in 4 cases, 3 of whom already had metastatic disease. None of the LR arose in the irradiated bone. The rate of non union was 9% at the 58 osteotomies, the greatest risk being in the tibia. There were four graft fractures of which 3 needed fixation and all united. There is one case of convincing graft resorbtion after 12 years. Two patients developed infections but there have been none since the done was routinely immersed in antibiotics whilst being irradiated. Conclusion: ECIR is a useful technique with very limited indications. In the majority of cases it works well. It appears particularly useful in pelvic resections and diaphyseal resections. Distal tibial reconstructions do worst. The irradiated bone needs reinforcing with either cement or a bone graft for best results