Radiographic analysis of extracorporeally irradiated autografts.

Abstract

To analyse the long-term radiographic findings of intercalary, pure osteoarticular, and composite bone grafts in patients with primary bone sarcoma who were treated by reimplantation of the bone as an orthotopic autograft. For this observational clinical study, 107 patients who presented with 108 malignant or locally aggressive benign bone tumours were treated by resection, extracorporeal irradiation (300 Gy), and reimplantation and fixation of the autograft. Bone healing features were evaluated with the International Society of Limb Salvage (ISOLS) graft evaluation method, which assesses fusion, resorption, fracture, graft shortening, fixation, subluxation, joint narrowing, and subchondral bone. A description of normal and abnormal healing patterns and complications comprised the secondary endpoint. Seventy-seven patients with complete radiographic data were selected for review. The mean ISOLS score was 78.2% (range 25.0-100%, median 79.2%). Three patient subgroups were created: intercalary graft, pure osteoarticular graft, and composite reconstruction consisting of an intercalary graft augmented with a prosthesis; the mean ISOLS scores were 81.3%, 70.7%, and 77.4%, respectively. Each item was scored individually, and no significant difference was observed (P = 0.225). This reconstruction technique is valid for the three methods described; bone stock is retained and, once the graft has healed, it behaves as normal bone. Close radiographic follow-up detects complications early, allowing timely interventions if necessary.