EN-BLOC RESECTION, EXTRACORPOREAL IRRADIATION, AND RE IMPLANTATION IN LIMB SALVAGE FOR BONY MALIGNANCIES. RESULTS FROM THE FIRST 50 CASES AT A MEAN OF 8.5 YEARS

Aim To review the first 50 cases, looking at survivorship of the irradiated autograft, complications and functional outcomes in a wide range of bony malignancies and anatomical locations. Methods 50 patients underwent en-bloc resection, extracorporeal irradiation with 50 Gy, and re-implantation for limb salvage between August 1996 and June 2003. Case notes and patients were reviewed. Results Mean follow up was 101 months (70-152). 39 (78%) patients are alive and disease free, 11 (22%) have died, 8 of which had high grade pelvic malignancy. Local recurrence occurred in 6 cases (12%). 4 pelvic chondrosarcomas, one pelvic Ewings sarcoma and one soft tissue recurrence in a high grade proximal humeral osteosarcoma. Graft failure was seen in 6 cases (12%), as defined by Mankin. Three were due to graft resorption; one proximal humerus and two acetabular. Two were in patients with recurrent disease, one requiring a shoulder disarticulation and one who died from pelvic disease. One patient fractured through a femoral graft after a mechanical fall. 10 (20%) of patients required grafting of the non union site +/− revision fixation, there were 3 (6%) superficial infections with no deep infections. Of the 38 disease free survivors, the Mankin score was excellent in 17, good 10, fair 9 and two failures. The mean Musculoskeletal Tumour Society Score was 82 and Toronto Extremity Salvage Score 84. Conclusions This method of limb salvage provides a biological reconstruction and compares favourably with the use of massive allografts and massive endoprostheses, with regard to complication rates and functional outcomes.