Use of irradiated autologous bone in joint sparing endoprosthetic femoral replacement tumor surgery

BACKGROUND: Joint preservation is usually attempted in cases of bone tumors, though insufficient bone following tumour resection may prevent fixation of conventional joint sparing prosthesis. To preserve the hip joint in skeletally immature patients, we have combined autologous proximal femoral irradiation and intercalary re-implantation with custom made distal femoral replacements. MATERIALS AND METHODS: A retrospective cohort study of four patients (aged 4-12 years); in whom irradiated autologous bone was combined with an extendable distal femoral endoprostheses was performed. There were three cases of osteosarcoma and one case of Ewing’s sarcoma. RESULTS: At a mean follow-up of 70.5 months (range 26-185 months), all four patients were alive without evidence of local recurrence. There was no evidence of metastatic disease in three patients while one patient showed chest metastatic disease at presentation. In all cases, the irradiated segment of bone united with the proximal femur and demonstrated bone ongrowth at the prosthetic collar. There were no cases of loosening or peri-prosthetic fracture. One implant was revised after 14 years following fracture of the extending component of the endoprosthesis. CONCLUSIONS: We report encouraging results utilizing irradiated autologous proximal femoral bone combined with distal femoral replacement in skeletally immature patients.