Intercalary endoprosthesis for salvage of failed intraoperative extracorporeal autogeneous irradiated bone grafting (IORBG) reconstruction

Intraoperative extracorporeal autogeneous irradiated bone grafting (IORBG) after femoral tumor resection ultimately sometimes will fail in patients achieving long-term survival. There are several alternative surgical approaches for revision of these reconstructions. In 2002 and 2005, two patients with femoral intercalary resection of malignant tumor (synovial sarcoma and MFH) underwent IORBG reconstruction with intramedullary nail or plate. At 32 and 96 months after IORBG reconstruction, both patients had failed IORBG (pathological fracture) in the femur. We used custom-made endoprostheses in these two patients to reconstruct femoral diaphyseal bone defect after excision of failed IORBG. Follow-up of the patients averaged 40.5 months (range, 39-42 months) after endoprosthetic revision. Musculoskeletal Tumor Society scores averaged 75% (66-83%). When used to salvage massive IORBG failure from fractures, intercalary endoprosthetic revision preserves limb function with minimal complications.