Distraction osteogenesis reconstruction following resection of bone sarcomas: Surgical, functional, and oncological outcomes from a prospective trial analysis Journal Article
| Authors: | Bozzo, A.; Aysola, V.; Yeung, C. M.; Healey, J. H.; Prince, D. E. |
| Article Title: | Distraction osteogenesis reconstruction following resection of bone sarcomas: Surgical, functional, and oncological outcomes from a prospective trial analysis |
| Abstract: | Background: While sustainable long-term function has been established for biological reconstruction with distraction osteogenesis (DO) following osseous resections, there is a paucity of published data informing surgeons and patients on important milestones in the reconstructive process. The objectives of this study were to determine when to expect complete bone healing and full weight-bearing as well as to quantify the influence of chemotherapy on the osseous regeneration process. Methods: Prospectively, pathological and clinical data were collected for 30 consecutive patients who underwent primary or secondary DO-based reconstruction following osseous resection from 2018 to 2021. Serial radiographs indicated the times to cortex formation and full union. An unpaired t test was used to compare the time required for full bone remodeling of segments transported with and without concurrent chemotherapy. Results: The average resection length was 13.6 cm (range, 4 to 22 cm). Patients underwent an average of 6.1 procedures (range, 1 to 14 procedures). Half (50%) of all procedures were planned, while half were unplanned procedures. All patients achieved full, independent weight-bearing at a median of 12 months (interquartile range [IQR], 9 to 16 months). For the 34 segments transported concurrently with chemotherapy, the mean bone healing index (BHI) was 2.3 ± 0.7, and the mean BHI was 1.2 ± 0.4 for the 25 segments without chemotherapy at any point during their transport (p < 0.0001). Conclusions: All 30 patients achieved full bone healing and independent weight-bearing at a median of 1 year postoperatively and continued to show functional improvement afterward. Surgeons and patients can expect bone healing to be nearly twice as fast for segments transported after completion of systemic chemotherapy compared with segments transported concurrently with adjuvant chemotherapy. COPYRIGHT © 2024 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED |
| Keywords: | osteosarcoma; adolescent; adult; child; clinical article; treatment outcome; aged; bone neoplasms; middle aged; bone tumor; debridement; young adult; plastic surgery; follow up; prospective study; prospective studies; sensitivity analysis; drug effect; physiology; length of stay; adjuvant chemotherapy; operation duration; surgery; radiography; bone development; tertiary health care; bone remodeling; weight bearing; epiphysis; bone regeneration; fracture healing; distraction osteogenesis; clinical outcome; procedures; weight-bearing; humans; human; male; female; article; plastic surgery procedures; osteogenesis, distraction; malignant fibrous histiocytoma of the lung |
| Journal Title: | Journal of Bone and Joint Surgery |
| Volume: | 106 |
| Issue: | 13 |
| ISSN: | 0021-9355 |
| Publisher: | Journal of Bone and Joint Surgery |
| Date Published: | 2024-07-03 |
| Start Page: | 1205 |
| End Page: | 1211 |
| Language: | English |
| DOI: | 10.2106/jbjs.23.00707 |
| PUBMED: | 38728434 |
| PROVIDER: | scopus |
| PMCID: | PMC12009652 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Daniel Prince -- Source: Scopus |
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