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Distraction osteogenesis seen as safe, efficacious for malignant bone neoplasms
Distraction osteogenesis yielded safe and effective results for patients who underwent primary and secondary reconstruction of malignant bone neoplasms, according to results presented at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting.
“By using the distraction osteogenesis method, we are able to save patients’ joints, which more traditional methods do not allow,” study co-author Molly F. Klima, PA, of Memorial Sloan-Kettering Cancer Center, told Healio.com/Orthopedics. “That allows them to have a normal long-term function because their joint is saved.”
Klima, Daniel E. Prince, MD, and colleagues reviewed adjuvant and neoadjuvant chemotherapy, radiation dose and timing, total defect size and complications among 44 patients who underwent distraction osteogenesis between August 2014 and March 2018. Distraction osteogenesis treatment was completed using an external fixator or an internal device in 70% and 30% of patients, respectively. Researchers used the Musculoskeletal Tumor Society score to assess functional and emotional outcomes.
Results showed the defect was in the lower extremity in 91% of cases and that 93% of cases underwent reconstruction due to primary neoplasm involving bone vs. 7% of cases that underwent reconstruction due to bone metastases. Researchers found a median total defect size of 14.25 cm in patients with tumors. According to results, 39% of patients received chemotherapy prior to distraction osteogenesis; 34% received chemotherapy before and after reconstruction surgery; and 9% of patients received radiation therapy before surgery.
“We thought that the chemotherapy would affect the patients more and we also thought that it might affect the bone regeneration process, but we found that it actually didn’t,” Klima said.
Researchers noted a major complication rate of 52% and a median Musculoskeletal Tumor Society score of 19 at last follow-up visit. Overall, results showed 36% of patients needed revision surgery. Although a Musculoskeletal Tumor Society score of greater than 15 led to fewer revision surgeries, researchers found no significant relationship between revision surgery and Musculoskeletal Tumor Society score.
“Although all the patients had [an] initial setback, which is expected with any surgery, they ultimately recover ... either close to where they were before surgery or equal to where they were,” Klima said. – by Casey Tingle
Reference:
Klima MF, et al. Short- and intermediate-term function after distraction osteogenesis for bone reconstruction in the upper and lower extremity. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 13-14, 2018; San Francisco.
Disclosure: Klima reports no relevant financial disclosures.
Perspective
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This study reveals the amazing power of distraction osteogenesis. When Ilizarov’s principles are followed (low-energy osteotomy, minimal soft tissue disruption, stable fixation, appropriate latency period and distraction using a regular rate and rhythm), successful bone regeneration can be accomplished even in patients receiving chemotherapy. Bone transport is a valuable tool for orthopedic oncologic surgeons to have in their limb reconstruction armamentarium. The authors demonstrate that it can successfully be applied to patients with bone defects secondary to neoplasm as an alternative to allografts or other reconstructive methods.
Director at Center for Limb Lengthening and Reconstruction
Clinical associate professor of orthopedic surgery
The Ohio State University, College of Medicine
Nationwide Children’s Hospital
Columbus, Ohio