The re-implantation of extracorporeally devitalised bone segments for defect reconstruction in tumour orthopaedics - A review of the literature

Purpose: The purpose of this paper is a review of the actual data about biological reconstruction by means of reimplantation of devitalised tumour bearing bone segments. Review of the literature: Both experimental and clinical investigations proved extracorporeal autoclaving or high-dose irradiation to be a secure method for killing tumour cells. Animal experiments demonstrated that incorporation of devitalised bone segments took place after intramedullary nailing as well as after plate osteosynthesis. Bony union was followed by a slow revitalisation of the bone. Biomechanical stability of the bone is reduced only after extremely high-dose irradiation. Autoclaving, however, may essentially impair biomechanics already after a short time of application high temperatures. The analysis of 115 patients with autoclaved re-implants and of 42 patients with irradiated reimplants showed encouraging functional long-term results when comparing to other biological reconstruction techniques. The time until consolidation was about 3 times longer than after osteotomies with well vascularised fragments on both sides. According to the data of the literature, the rate of local recurrences, fractures or deep infections was not higher than after other limb salvage procedures. Conclusion: Re-implantation of extracorporeally devitalised tumour bearing bone segments may be an excellent alternative reconstructive procedure in limb salvage for a small number of well selected patients. Stringent indication is most important for good results. Only patients who are willing and able for the differentiated aftertreatment should be considered and tumours with osteolyses essentially compromising stability should be excluded. Apart from general oncological necessities like adequate surgical margins, biomechanically correct osteosynthesis is most important in this alternative of reconstruction.