Progress in repair and reconstruction of large segmental bone tumor defect in distal tibia_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Kun , WANG Yanling , LU Minxun , YAO Kai , XIAO Cong , ZHOU Yong , MIN Li , LUO Yi ,  TU Chongqi

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

TU Chongqi, Email: tuchongqi@163.com

Keywords：

Distal tibia; large segmental bone tumor defect; repair and reconstruction

DOI：

10.7507/1002-1892.201803007

Video：

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Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia was reviewed and analyzed in terms of the reserved ankle joint and the non-reserved ankle joint. Results For large segmental bone tumor defect in distal tibia, the conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques can be selected, and the membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are gradually to be applied to repair the bone defect. Moreover, due to its long survival time, the function of reconstructed bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods has not yet been developed, great progress has been achieved in repair and reconstruction of the large segmental bone tumor defect in the distal tibia. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.

Citation： ZHAO Kun, WANG Yanling, LU Minxun, YAO Kai, XIAO Cong, ZHOU Yong, MIN Li, LUO Yi, TU Chongqi. Progress in repair and reconstruction of large segmental bone tumor defect in distal tibia. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1211-1217. doi: 10.7507/1002-1892.201803007 Copy

1.	冯乃实, 李瑞宗, 张学军, 等. 骨与关节肿瘤及瘤样病变 4 327 例统计分析. 中华骨科杂志, 1997, 17(12): 33-38.
2.	肖庆芳, 王全兵. 骨关节肿瘤的临床特点分析. 湖南中医药大学学报, 2013, 33(8): 85-86.
3.	辛林伟, 辛桂桐, 唐际存. 骨与关节肿瘤及瘤样病变 2 317 例统计分析. 中国骨肿瘤骨病, 2008, 7(4): 198-203.
4.	田志超, 蔡启卿, 高嵩涛, 等. 大段同种异体骨移植术在胫骨中段骨肉瘤保肢中的应用. 中国组织工程研究, 2014, 18(39): 6381-6385.
5.	Thompson RC Jr, Garg A, Clohisy DR, et al. Fractures in large-segment allografts. Clin Orthop Relat Res, 2000, (370): 227-235.
6.	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.
7.	Farfalli GL, Aponte-Tinao L, Lopez-Millán L, et al. Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics, 2012, 35(3): e391-e396.
8.	Ahlmann ER, Menendez LR. Intercalary endoprosthetic reconstruction for diaphyseal bone tumours. J Bone Joint Surg (Br), 2006, 88(11): 1487-1491.
9.	Hornicek FJ, Gebhardt MC, Tomford WW, et al. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res, 2001, (382): 87-98.
10.	Grover V, Kapoor A, Malhotra R, et al. Bone allografts: a review of safety and efficacy. Indian J Dent Res, 2011, 22(3): 496.
11.	Stevenson S, Emery SE, Goldberg VM. Factors affecting bone graft incorporation. Clin Orthop Relat Res, 1996, (324): 66-74.
12.	Ng VY, Louie P, Punt S, et al. Allograft Reconstruction for Sarcomas of the Tibia. Open Orthop J, 2017, 11: 189-194.
13.	Ghert M, Colterjohn N, Manfrini M. The use of free vascularized fibular grafts in skeletal reconstruction for bone tumors in children. J Am Acad Orthop Surg, 2007, 15(10): 577-587.
14.	Hsieh CH, Jeng SF, Chen SH, et al. Folded free vascularized fibular grafts for the reconstruction of combined segmental bone defects of distal tibia and fibula. J Trauma, 2004, 56(2): 437-439.
15.	Khira YM, Badawy HA. Pedicled vascularized fibular graft with Ilizarov external fixator for reconstructing a large bone defect of the tibia after tumor resection. J Orthop Traumatol, 2013, 14(2): 91-100.
16.	Chang DW, Weber KL. Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg, 2005, 116(7): 1918-1925.
17.	Li J, Wang Z, Guo Z, et al. The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy. J Surg Oncol, 2010, 102(5): 368-374.
18.	Sewell MD, Hanna SA, McGrath A, et al. Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. J Bone Joint Surg (Br), 2011, 93(8): 1111-1117.
19.	Fuchs B, Ossendorf C, Leerapun T, et al. Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol, 2008, 34(12): 1271-1276.
20.	Rabitsch K, Maurer-Ertl W, Pirker-Frühauf U, et al. Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma, 2013, 2013: 160295.
21.	Ozaki T, Hillmann A, Wuisman P, et al. Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors. Acta Orthop Scand, 1997, 68(3): 298-301.
22.	Zekry KM, Yamamoto N, Hayashi K, et al. Intercalary frozen autograft for reconstruction of malignant bone and soft tissue tumours. Int Orthop, 2017, 41(7): 1481-1487.
23.	Manabe J, Ahmed AR, Kawaguchi N, et al. Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res, 2004, (419): 258-266.
24.	Chen TH, Chen WM, Huang CK. Reconstruction after intercalary resection of malignant bone tumours: comparison between segmental allograft and extracorporeally-irradiated autograft. J Bone Joint Surg (Br), 2005, 87(5): 704-709.
25.	Chen WM, Wu PK, Chen CF, et al. High-grade osteosarcoma treated with hemicortical resection and biological reconstruction. J Surg Oncol, 2012, 105(8): 825-829.
26.	Jeon DG, Kim MS, Cho WH, et al. Pasteurized autograft for intercalary reconstruction: an alternative to allograft. Clin Orthop Relat Res, 2007, 456: 203-210.
27.	Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop, 2015, 49(5): 516-522.
28.	Demiralp B, Ege T, Kose O, et al. Reconstruction of intercalary bone defects following bone tumor resection with segmental bone transport using an Ilizarov circular external fixator. J Orthop Sci, 2014, 19(6): 1004-1011.
29.	Taylor BC, French BG, Fowler TT, et al. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg, 2012, 20(3): 142-150.
30.	Villemagne T, Bonnard C, Accadbled F, et al. Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique. J Pediatr Orthop, 2011, 31(5): 570-576.
31.	Accadbled F, Mazeau P, Chotel F, et al. Induced-membrane femur reconstruction after resection of bone malignancies: three cases of massive graft resorption in children. Orthop Traumatol Surg Res, 2013, 99(4): 479-483.
32.	Cui Q, Mihalko WM, Shields JS, et al. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg (Am), 2007, 89(4): 871-882.
33.	Aho OM, Lehenkari P, Ristiniemi J, et al. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg (Am), 2013, 95(7): 597-604.
34.	Viateau V, Guillemin G, Calando Y, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: an ovine model. Vet Surg, 2006, 35(5): 445-452.
35.	Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
36.	Apard T, Bigorre N, Cronier P, et al. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res, 2010, 96(5): 549-553.
37.	Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res, 2015, 473(6): 2067-2075.
38.	Chotel F, Nguiabanda L, Braillon P, et al. Induced membrane technique for reconstruction after bone tumor resection in children: a preliminary study. Orthop Traumatol Surg Res, 2012, 98(3): 301-308.
39.	郭骏, 刘欣伟, 解冰, 等. 膜诱导技术治疗胫骨大段骨缺损的临床研究. 局解手术学杂志, 2016, 25(10): 738-741.
40.	Sewell MD, Hanna SA, McGrath A, et al. Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. J Bone Joint Surg (Br), 2011, 93(8): 1111-1117.
41.	Ruggieri P, Mavrogenis AF, Bianchi G, et al. Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors. J Surg Oncol, 2011, 104(1): 83-90.
42.	Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg (Br), 2006, 88(12): 1642-1646.
43.	Seo SG, Kim EJ, Lee DJ, et al. Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults. Foot Ankle Int, 2017, 38(9): 1035-1044.
44.	Lou TF, Li H, Chai YM, et al. Resection arthrodesis using distraction osteogenesis then plating as a hybrid surgical technique for the management of bone sarcomas of the distal tibia. Int Orthop, 2018, 42(3): 705-711.
45.	Economopoulos K, Barker L, Beauchamp C, et al. Case report: reconstruction of the distal tibia with porous tantalum spacer after resection for giant cell tumor. Clin Orthop Relat Res, 2010, 468(6): 1697-1701.
46.	Shekkeris AS, Hanna SA, Sewell MD, et al. Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours. J Bone Joint Surg (Br), 2009, 91(10): 1378-1382.
47.	Yang P, Evans S, Khan Z, et al. Reconstruction of the distal tibia following resection of aggressive bone tumours using a custom-made megaprosthesis. J Orthop, 2017, 14(3): 406-409.
48.	Singer S, Klejman S, Pinsker E, et al. Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls. J Bone Joint Surg (Am), 2013, 95(24): e191-e191.
49.	Moore DR, Halpern JL, Schwartz HS. Allograft ankle arthrodesis: a limb salvage technique for distal tibial tumors. Clin Orthop Relat Res, 2005, 440: 213-221.

1. 冯乃实, 李瑞宗, 张学军, 等. 骨与关节肿瘤及瘤样病变 4 327 例统计分析. 中华骨科杂志, 1997, 17(12): 33-38.
2. 肖庆芳, 王全兵. 骨关节肿瘤的临床特点分析. 湖南中医药大学学报, 2013, 33(8): 85-86.
3. 辛林伟, 辛桂桐, 唐际存. 骨与关节肿瘤及瘤样病变 2 317 例统计分析. 中国骨肿瘤骨病, 2008, 7(4): 198-203.
4. 田志超, 蔡启卿, 高嵩涛, 等. 大段同种异体骨移植术在胫骨中段骨肉瘤保肢中的应用. 中国组织工程研究, 2014, 18(39): 6381-6385.
5. Thompson RC Jr, Garg A, Clohisy DR, et al. Fractures in large-segment allografts. Clin Orthop Relat Res, 2000, (370): 227-235.
6. 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.
7. Farfalli GL, Aponte-Tinao L, Lopez-Millán L, et al. Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics, 2012, 35(3): e391-e396.
8. Ahlmann ER, Menendez LR. Intercalary endoprosthetic reconstruction for diaphyseal bone tumours. J Bone Joint Surg (Br), 2006, 88(11): 1487-1491.
9. Hornicek FJ, Gebhardt MC, Tomford WW, et al. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res, 2001, (382): 87-98.
10. Grover V, Kapoor A, Malhotra R, et al. Bone allografts: a review of safety and efficacy. Indian J Dent Res, 2011, 22(3): 496.
11. Stevenson S, Emery SE, Goldberg VM. Factors affecting bone graft incorporation. Clin Orthop Relat Res, 1996, (324): 66-74.
12. Ng VY, Louie P, Punt S, et al. Allograft Reconstruction for Sarcomas of the Tibia. Open Orthop J, 2017, 11: 189-194.
13. Ghert M, Colterjohn N, Manfrini M. The use of free vascularized fibular grafts in skeletal reconstruction for bone tumors in children. J Am Acad Orthop Surg, 2007, 15(10): 577-587.
14. Hsieh CH, Jeng SF, Chen SH, et al. Folded free vascularized fibular grafts for the reconstruction of combined segmental bone defects of distal tibia and fibula. J Trauma, 2004, 56(2): 437-439.
15. Khira YM, Badawy HA. Pedicled vascularized fibular graft with Ilizarov external fixator for reconstructing a large bone defect of the tibia after tumor resection. J Orthop Traumatol, 2013, 14(2): 91-100.
16. Chang DW, Weber KL. Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg, 2005, 116(7): 1918-1925.
17. Li J, Wang Z, Guo Z, et al. The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy. J Surg Oncol, 2010, 102(5): 368-374.
18. Sewell MD, Hanna SA, McGrath A, et al. Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. J Bone Joint Surg (Br), 2011, 93(8): 1111-1117.
19. Fuchs B, Ossendorf C, Leerapun T, et al. Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol, 2008, 34(12): 1271-1276.
20. Rabitsch K, Maurer-Ertl W, Pirker-Frühauf U, et al. Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma, 2013, 2013: 160295.
21. Ozaki T, Hillmann A, Wuisman P, et al. Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors. Acta Orthop Scand, 1997, 68(3): 298-301.
22. Zekry KM, Yamamoto N, Hayashi K, et al. Intercalary frozen autograft for reconstruction of malignant bone and soft tissue tumours. Int Orthop, 2017, 41(7): 1481-1487.
23. Manabe J, Ahmed AR, Kawaguchi N, et al. Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res, 2004, (419): 258-266.
24. Chen TH, Chen WM, Huang CK. Reconstruction after intercalary resection of malignant bone tumours: comparison between segmental allograft and extracorporeally-irradiated autograft. J Bone Joint Surg (Br), 2005, 87(5): 704-709.
25. Chen WM, Wu PK, Chen CF, et al. High-grade osteosarcoma treated with hemicortical resection and biological reconstruction. J Surg Oncol, 2012, 105(8): 825-829.
26. Jeon DG, Kim MS, Cho WH, et al. Pasteurized autograft for intercalary reconstruction: an alternative to allograft. Clin Orthop Relat Res, 2007, 456: 203-210.
27. Borzunov DY, Balaev PI, Subramanyam KN. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop, 2015, 49(5): 516-522.
28. Demiralp B, Ege T, Kose O, et al. Reconstruction of intercalary bone defects following bone tumor resection with segmental bone transport using an Ilizarov circular external fixator. J Orthop Sci, 2014, 19(6): 1004-1011.
29. Taylor BC, French BG, Fowler TT, et al. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg, 2012, 20(3): 142-150.
30. Villemagne T, Bonnard C, Accadbled F, et al. Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique. J Pediatr Orthop, 2011, 31(5): 570-576.
31. Accadbled F, Mazeau P, Chotel F, et al. Induced-membrane femur reconstruction after resection of bone malignancies: three cases of massive graft resorption in children. Orthop Traumatol Surg Res, 2013, 99(4): 479-483.
32. Cui Q, Mihalko WM, Shields JS, et al. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg (Am), 2007, 89(4): 871-882.
33. Aho OM, Lehenkari P, Ristiniemi J, et al. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg (Am), 2013, 95(7): 597-604.
34. Viateau V, Guillemin G, Calando Y, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: an ovine model. Vet Surg, 2006, 35(5): 445-452.
35. Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
36. Apard T, Bigorre N, Cronier P, et al. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res, 2010, 96(5): 549-553.
37. Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res, 2015, 473(6): 2067-2075.
38. Chotel F, Nguiabanda L, Braillon P, et al. Induced membrane technique for reconstruction after bone tumor resection in children: a preliminary study. Orthop Traumatol Surg Res, 2012, 98(3): 301-308.
39. 郭骏, 刘欣伟, 解冰, 等. 膜诱导技术治疗胫骨大段骨缺损的临床研究. 局解手术学杂志, 2016, 25(10): 738-741.
40. Sewell MD, Hanna SA, McGrath A, et al. Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. J Bone Joint Surg (Br), 2011, 93(8): 1111-1117.
41. Ruggieri P, Mavrogenis AF, Bianchi G, et al. Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors. J Surg Oncol, 2011, 104(1): 83-90.
42. Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg (Br), 2006, 88(12): 1642-1646.
43. Seo SG, Kim EJ, Lee DJ, et al. Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults. Foot Ankle Int, 2017, 38(9): 1035-1044.
44. Lou TF, Li H, Chai YM, et al. Resection arthrodesis using distraction osteogenesis then plating as a hybrid surgical technique for the management of bone sarcomas of the distal tibia. Int Orthop, 2018, 42(3): 705-711.
45. Economopoulos K, Barker L, Beauchamp C, et al. Case report: reconstruction of the distal tibia with porous tantalum spacer after resection for giant cell tumor. Clin Orthop Relat Res, 2010, 468(6): 1697-1701.
46. Shekkeris AS, Hanna SA, Sewell MD, et al. Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours. J Bone Joint Surg (Br), 2009, 91(10): 1378-1382.
47. Yang P, Evans S, Khan Z, et al. Reconstruction of the distal tibia following resection of aggressive bone tumours using a custom-made megaprosthesis. J Orthop, 2017, 14(3): 406-409.
48. Singer S, Klejman S, Pinsker E, et al. Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls. J Bone Joint Surg (Am), 2013, 95(24): e191-e191.
49. Moore DR, Halpern JL, Schwartz HS. Allograft ankle arthrodesis: a limb salvage technique for distal tibial tumors. Clin Orthop Relat Res, 2005, 440: 213-221.

Chinese Journal of Reparative and Reconstructive Surgery

Progress in repair and reconstruction of large segmental bone tumor defect in distal tibia

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