Page 21 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

consequences are considerable, this technique allows patients to participate in 1 unrestricted physical activity and may yield functional results that are comparable
to endoprosthetic reconstructions. Moreover, these procedures are often de nitive;
the need for further surgical intervention is rare80-83. As opposed to limb-salvaging techniques, it may also be used in case the vessels are involved in the tumor.
Figure 10: Unassembled parts of the Kotz Modular Femur and Tibia Reconstruction System76.
To understand and compare the various techniques used for reconstruction of osseous defects in the extremities, it is important to distinguish between joint replacements and intercalary (joint-preserving) reconstructions. Primary extremity bone tumors preferentially a ect the meta-epiphyseal regions of the distal femur, proximal tibia, proximal humerus and proximal femur. Due to aggressive biological behavior, periarticular structures are frequently involved in the tumorous process, and partial or complete removal of the adjacent joint is commonly indicated1,14,28,84. Reconstruction can then be performed using an endoprosthesis85, an osteoarticular allograft86, or a combination of an allograft and a metallic implant – an allograft- prosthetic composite (APC)87. In other cases, however, it may be possible to salvage the joint and to perform an intercalary (segmental) resection. Several techniques have been described for reconstruction of segmental intercalary osseous defects, including allografts88, vascularized bular autografts89, a combination of the two – the “Capanna technique”90, extracorporeally irradiated autografts91, segmental (metallic) prostheses92, or bone transport with the Ilizarov technique93.
Traditionally, massive allograft implantation was the most common technique for reconstruction of intercalary defects94. Ready availability of well-procured and
General introduction
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