A reconstruction with extracorporeal irradiated autograft in osteosarcoma around the knee

BACKGROUND AND OBJECTIVES: An extracorporeal irradiated (ECI) autograft was first reported in Israel in 1968 for the treatment of primary malignant bone tumor. However, subsequent reports covered mostly short-term follow up results, and the reported results of reconstruction vary from study to study. We analyze the long-term follow up results of reconstruction using an extracorporeal irradiated (ECI) autograft in osteosarcoma around the knee. METHODS: We retrospectively reviewed 23 osteosarcoma patients who underwent reconstruction with ECI between December 1995 and April 2005. The 15 males and 8 females had a mean age of 21 years (range: 7-74) and a mean follow-up of 127 months(range: 57-170). Tumors were located in the distal femur in 14 cases, and the proximal tibia in 9 cases. Pathological types were conventional in 22 cases, and parosteal in 1 case. Resection methods were osteoarticular in 18 cases and total joint in 5 cases. Eighteen cases were reconstructed with the ECI autograft and five with ECI autograft-prosthesis composite (APC). The Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. RESULTS: The overall survival rate was 82.6%, and the disease-free survival rate was 69.5%. We found 20 complications, including 6 nonunions, 5 deep infections, 4 joint instabilities, 2 fractures, 1 limb-length discrepancy (LLD), 1 epiphyseal collapse, and 1 vessel occlusion. The average MSTS functional score was 62.6%. CONCLUSIONS: Reconstruction with an extracorporeal irradiated is not recommended for osteosarcoma around the knee.