Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method

Abstract

Objective: Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.

Methods: A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient’s general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.

Results: Eleven patients were followed up for an average of 66 months (range, 24–132 months). The average length of repaired bone defects was 13 cm (range, 2.5–32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing’s sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21–30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.

Conclusion: The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.

Keywords

bone defect / bone tumor / Ilizarov method / limb salvage / reconstruction

References

[1] O. Hovav, S. Kolonko, S. F. Zahir, G. Velli, P. Chouhan, and M. Wagels, “Limb Salvage Surgery Reconstructive Techniques Following Long-Bone Lower Limb Oncological Resection: A Systematic Review and Meta-Analysis,” ANZ Journal of Surgery 93, no. 11 (2023): 2609–2620,

[2] S. Huang, H. Li, Z. Xing, T. Ji, and W. Guo, “Factors Influencing Nonunion and Fracture Following Biological Intercalary Reconstruction for Lower-Extremity Bone Tumors: A Systematic Review and Pooled Analysis,” Orthopaedic Surgery 14, no. 12 (2022): 3261–3267,

[3] E. R. Henderson, M. I. O’Connor, P. Ruggieri, et al., “Classification of Failure of Limb Salvage After Reconstructive Surgery for Bone Tumours : A Modified System Including Biological and Expandable Reconstructions,” Bone and Joint Journal 96-B, no. 11 (2014): 1436–1440,

[4] S. Miwa, N. Yamamoto, K. Hayashi, A. Takeuchi, K. Igarashi, and H. Tsuchiya, “Surgical Site Infection After Bone Tumor Surgery: Risk Factors and New Preventive Techniques,” Cancers 14, no. 18 (2022): 1–12,

[5] H. J. Mankin, F. J. Hornicek, and K. A. Raskin, “Infection in Massive Bone Allografts,” Clinical Orthopaedics and Related Research 432, no. 432 (2005): 210–216,

[6] M. K. Gundavda, A. Katariya, R. Reddy, and M. G. Agarwal, “Fighting Megaprosthetic Infections: What Are the Chances of Winning?,” Indian Journal of Orthopaedics 54, no. 4 (2020): 469–476,

[7] A. K. Williams, B. Crawford, N. C. Federman, N. Bernthal, and A. Arkader, “What’s New in Pediatric Orthopaedic Tumor Surgery,” Journal of Pediatric Orthopedics 41, no. 2 (2021): E174–E180,

[8] L. M. Kelley, M. Schlegel, S. Hecker-Nolting, et al., “Pathological Fracture and Prognosis of High-Grade Osteosarcoma of the Extremities: An Analysis of 2, 847 Consecutive Cooperative Osteosarcoma Study Group (COSS) Patients,” Journal of Clinical Oncology 38, no. 8 (2020): 823–833,

[9] M. San-Julián, J. Gómez-Álvarez, M. Idoate, J. D. Aquerreta, B. Vázquez-García, and J. M. Lamo-Espinosa, “Epiphyseal Distraction Prior to Resection in Paediatric Bone Sarcomas: Four Decades of Experience,” Bone and Joint Journal 105-B, no. 1 (2023): 11–16,

[10] T. Ji, Y. Yang, D.-S. Li, X. D. Tang, and W. Guo, “Limb Salvage Using Non-hinged Endoprosthesis and Staged Correction of Leg-Length Discrepancy for Children With Distal Femoral Malignant Tumors,” Orthopaedic Surgery 11, no. 5 (2019): 819–825,

[11] T. Lin, Q. Jin, X. Mo, et al., “Experience With Periprosthetic Infection After Limb Salvage Surgery for Patients With Osteosarcoma,” Journal of Orthopaedic Surgery and Research 16, no. 1 (2021): 1–9,

[12] C. B. Kong, S. Y. Lee, and D. G. Jeon, “Staged Lengthening Arthroplasty for Pediatric Osteosarcoma Around the Knee,” Clinical Orthopaedics and Related Research 468, no. 6 (2010): 1660–1668,

[13] K. D. Tetsworth and C. E. Dlaska, “The Art of Tibial Bone Transport Using the Ilizarov Fixator: The Suspension Wire Technique,” Techniques in Orthopaedics 30, no. 3 (2015): 142–155,

[14] Z. Li, J. Liu, C. Li, et al., “Advances in the Application of Bone Transport Techniques in the Treatment of Bone Nonunion and Bone Defects,” Orthopaedic Surgery 15, no. 12 (2023): 3046–3054,

[15] S. Paul, M. Vathulya, P. Kandwal, M. Jagtap, and R. Behl, “Comparative Analysis of Free Vascularized Fibula Grafting and Ilizarov Bone Transport in Management of Segmental Long Bone Defect of the Lower Limb: A Systematic Review and Meta-Analysis,” Journal of Orthopaedics 50 (2024): 84–91,

[16] L. Groszman, A. Nooh, M. Bernstein, and A. Aoude, “The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes,” SN Comprehensive Clinical Medicine 5, no. 1 (2023): 1–11,

[17] L. van der Heijden, G. L. Farfalli, I. Balacó, et al., “Biology and Technology in the Surgical Treatment of Malignant Bone Tumours in Children and Adolescents, With a Special Note on the Very Young,” Journal of Children’s Orthopaedics 15, no. 4 (2021): 322–330,

[18] J. I. Albergo, C. L. Gaston, L. A Aponte-Tinao, et al., “Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?,” Clinical Orthopaedics and Related Research 475, no. 3 (2017): 676–682,

[19] L. Aponte-Tinao, M. A. Ayerza, D. L. Muscolo, and G. L. Farfalli, “Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee,” Clinical Orthopaedics and Related Research 473, no. 5 (2015): 1789–1796,

[20] L. A Aponte-Tinao, M. A. Ayerza, J. I. Albergo, and G. L. Farfalli, “Do Massive Allograft Reconstructions for Tumors of the Femur and Tibia Survive 10 or More Years After Implantation?,” Clinical Orthopaedics and Related Research 478, no. 3 (2020): 517–524,

[21] Q. Liu, Z. Liu, H. Guo, M. Wang, J. Liang, and Y. Zhang, “A Comparative Study of Bone Union and Nonunion During Distraction Osteogenesis,” BioMed Central Musculoskeletal Disorders 23, no. 1 (2022): 1–7,

[22] T. Ozaki, Y. Nakatsuka, T. Kunisada, et al., “High Complication Rate of Reconstruction Using Ilizarov Bone Transport Method in Patients With Bone Sarcomas,” Archives of Orthopaedic and Trauma Surgery 118, no. 3 (1998): 136–139,

[23] T. H. McCoy, H. J. Kim, M. B. Cross, et al., “Bone Tumor Reconstruction With the Ilizarov Method,” Journal of Surgical Oncology 107, no. 4 (2013): 343–352,

[24] H. Matsubara and H. Tsuchiya, “Treatment of Bone Tumor Using External Fixator,” Journal of Orthopaedic Science 24, no. 1 (2019): 1–8,

[25] W. Wang, J. Yang, Y. Wang, et al., “Bone Transport Using the Ilizarov Method for Osteosarcoma Patients With Tumor Resection and Neoadjuvant Chemotherapy,” Journal of Bone Oncology 16, no. August 2018 (2019): 100224,

[26] Y. Liu, M. Yushan, Z. Liu, J. Liu, C. Ma, and A. Yusufu, “Complications of Bone Transport Technique Using the Ilizarov Method in the Lower Extremity: A Retrospective Analysis of 282 Consecutive Cases Over 10 Years,” BioMed Central Musculoskeletal Disorders 21, no. 1 (2020): 1–9,

[27] M. Yushan, P. Ren, A. Abula, et al., “Bifocal or Trifocal (Double-Level) Bone Transport Using Unilateral Rail System in the Treatment of Large Tibial Defects Caused by Infection: A Retrospective Study,” Orthopaedic Surgery 12, no. 1 (2020): 184–193,

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.