Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients

Abstract

Background: The commonly used reconstructive options after post resection defects in bone tumors like megaprosthesis, autograft, allograft, bone graft substitutes and recycled bone have their own demerits on a long term. Bone transport that regenerates patient's own bone is a less explored option of reconstruction after resection of benign bone tumors and reports on this are limited. This technique is very much relevant in tibia where Ilizarov fixator is surgeon and patient friendly. We report our experience.

Materials and methods: This is a retrospective series of resection and bone transport in 38 patients with benign tumor of tibia. There were 14 males and 24 females with mean age of 23.40 years (range 9-40 years). Lesion was located in proximal third tibia in 27, middle third in two and distal third in nine patients. The diagnosis was giant cell tumor in 32, chondroblastoma in three, chondromyxoid fibroma, enchondroma and desmoplasic fibroma in one patient each. The resection was intercalary in 28 and transarticular in 10 patients. Osteosynthesis was monofocal in three, bifocal in 31 and polyfocal in four cases.

Results: Mean followup was 7.22 years (range 1.5-15 years). Mean resection length was 10.21 cm (range 3-22 cm). The mean duration of external fixator was 308.03 days (range 89-677 days) and mean external fixator index was 36.14 days/cm (range 16.84-97.43 days/cm). Twelve patients had difficulties in the form of 11 problems and five obstacles that were successfully managed. None of the patients had local recurrence of tumor or any long term complication. Mean Musculo-skeletal Tumour Society score at final followup was 27.18 (90.60%).

Conclusions: Bone transport is an excellent option after resection of benign tumors of tibia with good local control and functional outcome, despite minor difficulties that need timely management.

Keywords: Benign bone tumor; Ilizarov technique; bone defect; bone lengthening; bone neoplasms; bone transport; distraction; distraction osteogenesis; ilizarov; osteogenesis; resection.

Figure 1

(a) X-rays anteroposterior and lateral views of leg bones with ankle of a 33 year old female with giant cell tumor of left distal tibia. (b-d) X-rays leg bones anteroposterior and lateral views during the period of distraction osteogenesis to fill up 8 cm defect after transarticular resection. (e) X-rays leg bones anteroposterior and lateral views showing consolidation (f) clinical photograph at 1 year followup

Figure 2A

(a) X-rays leg bones with knee joint anteroposterior and later views of 18 year old female showing aggressive chondroblastoma of proximal third of right tibia (b) X-rays during bone transport to fill up 17 cm after joint sparing resection

Figure 2B

(a) X-rays of same patient showing bone transport in progress (b) X-rays anteroposterior and lateral views at 15 years followup showing very good consolidation (c) Clinical photograph at 15 years folowup showing range of motion

Figure 3A

(a) X-rays anteroposterior and lateral views of a 32 year old male showing recurrent giant cell tumour of proximal tibia (b) Reconstruction of 19 cm defect by lengthening of tibial and femoral segments using bone transport with Ilizarov (c) X-rays after removal of fixator showing femoral and tibial regenerate and arthrodesis

Figure 3B

(a) X-rays at 5 years followup showing consolidation (b) Clinical photograph at 5 year followup showing patient full weight bearing

Figure 4

(a) X-rays ankle joint with distal half of leg of a patient with Giant cell tumour of distal tibia (b) X-rays during bone transport to compensate 11 cm defect. (c) clinical photographs during bone transport showing ilizarov fixator in situ (d) X-rays anteroposterior and lateral views at 5 years followup showing consolidation