Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor

Abstract

Purpose : This study evaluated the effectiveness of a low-heat treated intercalary autograft reconstruction in primary malignant bone tumors mainly involving the diaphysis. Materials and Methods : Twenty patients who had primary malignant bone tumors underwent a low-heat treated intercalary autograft reconstruction between May 1987 and May 2004. The mean age was 24 years, and the mean follow up was 59.8 months. Osteosynthesis between host bone and low-heat treated autograft was carried out using plates and screws (n=7), rigid IM nails (n=6), plates and flexible IM nails or K-wires (n=4), and rigid IM nail and plate (n=3). Intramedullary cement augmentation was performed in 10 patients but the primary bone graft on the host-graft junction was not performed. Results : The mean segmental excised bone length was 152 mm. One patient died from acute cardiac arrest unrelated to the tumor but there was no local recurrence and metastasis. Host graft union was achieved in 18 patients after a mean of 8.5 months after surgery. Complications were observed in 7 patients (35%), including 3 fractures, 2 nonunions, and 2 infections. The mean functional outcome was 82% (24.6). Conclusion : A low-heat treated intercalary autograft is a simple, economic and best fitting reconstruction system with a low rate of ultimate failure in carefully selected patients. However, a long term study will be needed to evaluate the graft incorporation and possibility of bone resorption.