Effectiveness of unicompartment allografts replacement for bone tumor around the knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Junqi ,  BI Wenzhi , HAN Gang , JIA Jinpeng , XU Meng , WANG Wei

Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

BI Wenzhi, Email: biwenzhi@sina.com

Keywords：

Bone tumor; limb salvage; allogenic bone; unicompartmental arthroplasty; reconstruction

DOI：

10.7507/1002-1892.201704044

Video：

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ObjectiveTo analyze the effectiveness of unicompartment allografts replacement for reconstructing bone defect after bone tumor resection around knee.MethodsBetween January 2007 and January 2014, a total of 9 patients received unicompartment allografts replacement to treat bone tumor around the knee, including 6 males and 3 females, with an average age of 25.8 years (range, 17-38 years). There were 7 patients with bone giant cell tumor (postoperative recurrence of bone giant cell tumor in 1 case) and 2 patients with chondromyxoid fibroma. The tumors were located at the distal femur in 7 cases and proximal tibia in 2 cases, and the tumors were almost at the lateral limbs. The symptom duration was 2-5 months (mean, 3.2 months). The size of lesion ranged from 6 cm×2 cm to 9 cm×4 cm by X-ray film and MRI; and the metastasis was excluded by CT. The length of the allograft was 8.0-9.2 cm (mean, 8.6 cm).ResultsThe intraoperative blood loss volume was 400-550 mL (mean, 480 mL); and 0-3 U of erythrocyte was transfused after operation. The continuous exudate of incision occurred in 1 patient, and cured after 3 months; the other incisions healed primarily at 2 weeks after operation. All patients were followed up 3-10 years (mean, 6 years). No operation area infection, allograft bone poor healing or rupture was found. At 1 year after operation, the knee range of motion was 90-110° (mean, 100°); the Musculoskeletal Tumor Society score was 24-29 (mean, 26). Low density area (osteolysis) was found in 6 allografts; no articular surface collapse, hairline fracture, or fracture was found in patients; callus formation was observed in the contact surface between the allograft and the host bone, and the cortical bone showed good continuity.ConclusionUnicompartment allografts replacement can provide good support and function in terms of bone tumor resection, and achieve good effectiveness by biological reconstruction.

Citation： HUANG Junqi, BI Wenzhi, HAN Gang, JIA Jinpeng, XU Meng, WANG Wei. Effectiveness of unicompartment allografts replacement for bone tumor around the knee. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 908-912. doi: 10.7507/1002-1892.201704044 Copy

1.	Collins M, Wilhelm M, Conyers R, et al. Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis. J Clin Oncol, 2013, 31(18): 2303-2312.
2.	Palmerini E, Colangeli M, Nanni C, et al. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas. Eur J Nucl Med Mol Imaging, 2017, 44(2): 215-223.
3.	Okita Y, Tatematsu N, Nagai K, et al. Compensation by nonoperated joints in the lower limbs during walking after endoprosthetic knee replacement following bone tumor resection. Clin Biomech (Bristol, Avon), 2013, 28(8): 898-903.
4.	Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
5.	Griffin AM, Parsons JA, Davis AM, et al. Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop Relat Res, 2005, 438: 71-79.
6.	Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Use of distal femoral osteoarticular allografts in limb salvage surgery. J Bone Joint Surg (Am), 2005, 87(11): 2449-2455.
7.	Deijkers RL, Bloem RM, Kroon HM, et al. Epidiaphyseal versus other intercalary allografts for tumors of the lower limb. Clin Orthop Relat Res, 2005, 439: 151-160.
8.	Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421): 232-239.
9.	Biau DJ, Dumaine V, Babinet A, et al. Allograft prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res, 2007, 456: 211-217.
10.	Liang H, Ji T, Zhang Y, et al. Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J, 2017, 99-B(2): 267-275.
11.	Whelan JS, Jinks RC, McTiernan A, et al. Survival from high-grade localised extremity osteosarcoma: combined results and prognostic factors from three European Osteosarcoma Intergroup randomized controlled trials. Ann Oncol, 2012, 23(6): 1607-1616.
12.	Neville RF, Kayssi A. Development of a Limb-Preservation Program. Blood Purif, 2017, 43(1-3): 218-225.
13.	Pajarinen J, Lin TH, Nabeshima A, et al. Mesenchymal stem cells in the aseptic loosening of total joint replacements. J Biomed Mater Res A, 2017, 105(4): 1195-1207.
14.	Flint MN, Griffin AM, Bell RS, et al. Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop Relat Res, 2006, 450: 52-59.
15.	Grimer RJ, Aydin BK, Wafa H, et al. Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone. Bone Joint J, 2016, 98-B(6): 857-864.
16.	Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Use of distal femoral osteoarticular allografts in limb salvage surgery. Surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 2: 305-321.
17.	Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg (Am), 2001, 83-A(7): 971-986.
18.	Godoy-Santos AL, Amodio DT, Pires A, et al. Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report. Diabet Foot Ankle, 2017, 8(1): 1270076.
19.	Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res, 2004, (426): 97-102.
20.	Hornicek FJ, Gebhardt MC, Tomford WW, et al. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res, 2001, (382): 87-98.
21.	Mankin HJ, Gebhardt MC, Jenning LC, et al. Long-term result of allograft replacement in management of bone tumour. Clin Orthop Relat Res, 1999, (324): 86-87.
22.	Donati D, Colangeli M, Colangeli S, et al. Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res, 2008, 466(2): 459-465.
23.	Farid Y, Lin PP, Lewis VO, et al. Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res, 2006, (442): 223-229.
24.	Jentzsch T, Erschbamer M, Seeli F, et al. Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia. Clin Orthop Relat Res, 2013, 471(7): 2333-2339.
25.	Gosheger G, Hillmann A, Lindner N, et al. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res, 2001, (393): 264-271.
26.	Deijkers RL, Bloem RM, Kroon HM, et al. Epidiaphyseal versus other intercalary allografts for tumors of the lower limb. Clin Orthop Relat Res, 2005, (439): 151-160.
27.	Bullens PH, Minderhoud NM, de Waal Malefijt MC, et al. Survival of massive allografts in segmental oncological bone defect reconstructions. Int Orthop, 2009, 33(3): 757-760.
28.	Dick HM, Strauch RJ. Infection of massive bone allografts. Clin Orthop Relat Res, 1994, (306): 46-53.
29.	Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop Relat Res, 2005, (432): 210-216.
30.	Delloye C, De Halleux J, Cornu O, et al. Organizational and investigational aspects of bone banking in Belgium. Acta Orthop Belg, 1991, 57 Suppl 2: 27-34.

1. Collins M, Wilhelm M, Conyers R, et al. Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis. J Clin Oncol, 2013, 31(18): 2303-2312.
2. Palmerini E, Colangeli M, Nanni C, et al. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas. Eur J Nucl Med Mol Imaging, 2017, 44(2): 215-223.
3. Okita Y, Tatematsu N, Nagai K, et al. Compensation by nonoperated joints in the lower limbs during walking after endoprosthetic knee replacement following bone tumor resection. Clin Biomech (Bristol, Avon), 2013, 28(8): 898-903.
4. Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
5. Griffin AM, Parsons JA, Davis AM, et al. Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop Relat Res, 2005, 438: 71-79.
6. Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Use of distal femoral osteoarticular allografts in limb salvage surgery. J Bone Joint Surg (Am), 2005, 87(11): 2449-2455.
7. Deijkers RL, Bloem RM, Kroon HM, et al. Epidiaphyseal versus other intercalary allografts for tumors of the lower limb. Clin Orthop Relat Res, 2005, 439: 151-160.
8. Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421): 232-239.
9. Biau DJ, Dumaine V, Babinet A, et al. Allograft prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res, 2007, 456: 211-217.
10. Liang H, Ji T, Zhang Y, et al. Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J, 2017, 99-B(2): 267-275.
11. Whelan JS, Jinks RC, McTiernan A, et al. Survival from high-grade localised extremity osteosarcoma: combined results and prognostic factors from three European Osteosarcoma Intergroup randomized controlled trials. Ann Oncol, 2012, 23(6): 1607-1616.
12. Neville RF, Kayssi A. Development of a Limb-Preservation Program. Blood Purif, 2017, 43(1-3): 218-225.
13. Pajarinen J, Lin TH, Nabeshima A, et al. Mesenchymal stem cells in the aseptic loosening of total joint replacements. J Biomed Mater Res A, 2017, 105(4): 1195-1207.
14. Flint MN, Griffin AM, Bell RS, et al. Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop Relat Res, 2006, 450: 52-59.
15. Grimer RJ, Aydin BK, Wafa H, et al. Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone. Bone Joint J, 2016, 98-B(6): 857-864.
16. Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Use of distal femoral osteoarticular allografts in limb salvage surgery. Surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 2: 305-321.
17. Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg (Am), 2001, 83-A(7): 971-986.
18. Godoy-Santos AL, Amodio DT, Pires A, et al. Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report. Diabet Foot Ankle, 2017, 8(1): 1270076.
19. Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res, 2004, (426): 97-102.
20. Hornicek FJ, Gebhardt MC, Tomford WW, et al. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res, 2001, (382): 87-98.
21. Mankin HJ, Gebhardt MC, Jenning LC, et al. Long-term result of allograft replacement in management of bone tumour. Clin Orthop Relat Res, 1999, (324): 86-87.
22. Donati D, Colangeli M, Colangeli S, et al. Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res, 2008, 466(2): 459-465.
23. Farid Y, Lin PP, Lewis VO, et al. Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res, 2006, (442): 223-229.
24. Jentzsch T, Erschbamer M, Seeli F, et al. Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia. Clin Orthop Relat Res, 2013, 471(7): 2333-2339.
25. Gosheger G, Hillmann A, Lindner N, et al. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res, 2001, (393): 264-271.
26. Deijkers RL, Bloem RM, Kroon HM, et al. Epidiaphyseal versus other intercalary allografts for tumors of the lower limb. Clin Orthop Relat Res, 2005, (439): 151-160.
27. Bullens PH, Minderhoud NM, de Waal Malefijt MC, et al. Survival of massive allografts in segmental oncological bone defect reconstructions. Int Orthop, 2009, 33(3): 757-760.
28. Dick HM, Strauch RJ. Infection of massive bone allografts. Clin Orthop Relat Res, 1994, (306): 46-53.
29. Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop Relat Res, 2005, (432): 210-216.
30. Delloye C, De Halleux J, Cornu O, et al. Organizational and investigational aspects of bone banking in Belgium. Acta Orthop Belg, 1991, 57 Suppl 2: 27-34.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of unicompartment allografts replacement for bone tumor around the knee

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