Operative treatment of primary bone tumours of the femur and the tibia

Abstract

Introduction: Benign bone tumours of the long bones of the lower limbs are accessible to surgical treatment by resection of the tumour and reconstruction of the loss of bone substance by intercalary allograft. Massive allografts have a primary mechanical strength but pose the problem of the frequent complications that they can cause infection, pseudoarthrosis and pathological fracture.

Objective: The purpose of this study was to present the results of this conservative surgery in 15 patients.

Methods: A continuous retrospective study was carried out at the Trauma and Orthopaedics Department of the Rennes University Hospital, covering 15 interlayer allografts performed on 15 patients over a period of 16 years. Tumour resection followed the principles of surgery of primitive malignant bone tumours. The tumour was removed as a whole leaving a layer of healthy tissue in contact with the tumour. The height of the bone sections was determined on the preoperative Magnetic Resonance Imaging (MRI), performed before chemotherapy if necessary, in order to leave a margin of two centimetres of healthy bone.

Results: The average age of the series was 34.2 years (9 to 61 years). There were 8 (53.4%) female patients and 7 (46.6%) male patients. In patients with primary bone tumours of the tibia and of the femur, tumour resection was performed on the femur 11 times and on the tibia 4 times. Out of 35 surgeries, 15 cases of first surgery and 20 cases of second surgery, all of the grafts consolidated with an average period of 16 years (11 to 25 years). There were 20% cases of infections cases and 13.3% cases of fractures.

Conclusion: This study shows that consolidation of the intercalary allograft is still obtained, but after several re-surgeries.

Keywords: Bone tumour, Femur, Tibia, Resection, Allograft