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- Title
Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth.
- Authors
Zucchini, Riccardo; Staals, Eric Lodewijk; Fiore, Michele; Campanacci, Laura; Giannini, Claudio; Manfrini, Marco; Donati, Davide Maria
- Abstract
Purpose: Allograft reconstruction with or without vascularized fibula can be a valuable solution to treat childhood intercalary tumours of the distal femur. We aimed to assess the oncological status, complication rate and survival of distal femur intercalary reconstruction after trans-metaphyseal (TMR) and trans-epiphyseal resection (TER). We also evaluated the impact of distal temporary graft fixation on skeletal growth after TMR. Methods: We retrospectively reviewed 23 skeletally immature patients affected by distal femur osteosarcoma (18) and Ewing sarcoma (5). Mean patients age was 10.3 years. In 11 cases, TMR was performed with physis preservation and temporary distal graft fixation. In 9 patients, TER was performed with growth plate sacrifice. The last 3 cases were treated with TMR and sliding plate fixation. Results: Mean follow-up was 8.4 years. No deaths occurred, but 3 patients presented lung metastasis and 2 cases presented local recurrence in soft tissues. 10 implant-related complications occurred, all surgically treated. At skeletal maturity, mean femoral dysmetria was 2.3 cm after TMR and temporary epiphysiodesis, and 3.1 cm after TER. In TMR group, a strong trend towards physeal recovery was observed after epiphyseal screws removal (p = 0.061), but valgus deformity in distal femur was more frequent (p = 0.049). MSTS score was good or excellent in all patients, with no statistically significant difference between TMR and TER. Conclusions: Intercalary graft reconstruction after TMR and TER allows good local disease control and excellent functional results with long-term follow-up. Temporary distal fixation might reduce the final limb discrepancy after TMR, but valgus deformity could develop. Level of evidence: Level IV.
- Subjects
FEMUR surgery; CANCER prognosis; ONCOLOGIC surgery; PROSTHETICS; ORTHOPEDIC implants; HOMOGRAFTS; OSTEOSARCOMA; FUNCTIONAL status; PLASTIC surgery; SURGICAL complications; RETROSPECTIVE studies; LUNG tumors; CANCER relapse; ARTIFICIAL implants; TUMORS in children; TREATMENT effectiveness; SOFT tissue tumors; LEG; FEMUR; BONE grafting; EWING'S sarcoma; DISEASE risk factors
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2022, Vol 32, Issue 8, p1651
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-021-03149-z