Limb salvage using original low heat-treated tumor-bearing bone

Abstract

Limb salvage, using original low heat-treated tumor-bearing bone and a conventional joint prosthesis, was done in six patients with malignant tumors of the proximal humerus (one patient with chondrosarcoma and five patients with osteosarcoma) and in six patients with tumor of the proximal femur (two patients with malignant spindle cell sarcoma and four patients with osteosarcoma). Wide excision of the lesion was done and the tumor and surrounding soft tissues were removed. The excised bone was treated with heat and the prosthesis was inserted into the treated bone and fixed with cement. This construct was reinserted into the original site and anchored to the host bone with a plate. The overall union rate of the low heat-treated bone with normal host bone was 91.7%, and the mean union time was 4.6 months (range, 3-7 months) after surgery. The functional result of the proximal femur and proximal humerus were 76.7% and 56.8%, respectively, using the Musculoskeletal Tumor Society functional evaluation system. Complications included hip dislocation in one patient, fracture of the low heat-treated bone in two patients, and absorption of the low heat-treated bone of the humerus in four of six patients. The 5-year survival rate of the low heat-treated tumor-bearing bone was 83.3% using Kaplan-Meier survival analysis. Based on the results of this study, limb salvage using original low heat-treated tumor-bearing bone seems to be effective in treating primary bone sarcoma with high survival and acceptable complication rates, circumventing the complications of allograft bone.