Reconstruction with pasteurized autograft for primary malignant bone tumor of distal tibia

Objective. The aim of this study was to assess the specific protocol for the treatment of primary malignant bone tumors of distal tibiae in a group of patients for limb salvage, with wide "en bloc" intra-articular excision and reconstruction of the defect with recycled pasteurized autograft, which was stabilized using an internal fixator. Methods. Between 1994 and 2009, ten patients (three females and seven males) at a mean age of 26.5 years old were treated for malignant bone tumors of the distal tibiae with "en bloc" intra-articular excision and ankle arthrodesis using recycled pasteurized autograft. Nine cases were histopathologically diagnosed as high-grade osteosarcoma, and one case as invasive osteoblastoma. All bone tumors were staged according to Enneking's criteria with two stages IIA cases, and eight stages IIB cases. Results. At a mean follow-up of 81 months, the mean postoperative functional scorewas 74.3%. All the patients had bony union at the last follow-up. Six patients required secondary iliac crest cancellous bone grafting at the proximal end to achieve union. The mean time for graft union was 18.9 months, and the average union time of the proximal junctions was longer than that of the distal junctions. Superficial infection occurred in two patients (20.0%), which were resolved by changing dress. There was no deep infection or graft fracture during the entire procedure. Conclusions. The use of pasteurized bone graft for primary malignant bone tumors of distal tibia indicated a satisfactory outcome, with regard to graft survival, complications, and functional results. A pasteurized auto-graft can be an easily accessible and economical alternative of high efficiency for the usual reconstruction modalities.