Recycled tumor bone and/or vascularised fibula graft reconstruction for intercalary resections for sarcoma of femur.

Abstract

Sarcomas of bone requiring an intercalary resection of femur are rare and challenging. In the absence of set guidelines, they are variously managed with intercalary prosthesis, cement spacers, allografts, recycled tumor bone, and autografts. We have used recycled tumor bone and/or vascularised fibula over the years for such resections. In this first-of-its-kind study on Indian patients, we aim to analyse the outcome of these procedures in femur. Twenty six patients undergoing an intercalary resection of femur from 2011 to 2024 by a single surgeon were analysed, of which one was excluded. All the patients underwent intercalary resection and reconstruction using recycled tumor and/or vascularised fibula. The demographic and surgical details, time to union, functional outcome and complications were analysed. 21 patients were treated with reimplantation of recycled tumor bone (extracorporeal radiation therapy (ECRT) in 15 and cryotherapy in 6). A vascularised fibula graft was used in 17 patients; as a stand-alone graft in 4 and in combination with recycled tumor bone in 13. After a mean follow up of 61.3 months (3-144 months), all patients showed union. Addition of a vascularised fibula graft to recycled tumor bone reduced the time to union (p = 0.02) without increasing the risk of a complication. Additionally, patients undergoing cryotherapy had shorter time to union (6.83 months) when compared to those who underwent ECRT (14.43 months), with fewer complications. (P = 0.02). Use of a vascularised fibula as a stand-alone graft took the maximum time to union. Resection length did not correlate with complication rates and functional outcome. Biological reconstruction after an intercalary resection of femur gives excellent long term results, with acceptable complication rates. We recommend the addition of a vascularised fibula graft to recycled tumor bone for intercalary resections of femur. Pedicled cryotherapy for recycling of tumor bone, when feasible, leads to fastest rehabilitation to optimal function.