Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade XXXX of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts.

@entity1 @entity242 @entity5 @entity281 @entity3 @entity1642 @entity1516
Wide resection is an acceptable alternative to amputation for the management of primary @entity242 of the long bones or pelvis. The resected bone can be debrided of gross @entity5 tissue, autoclaved, and then replaced over intramedullary fixation to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. Resection and replacement for 28 low-grade (G1) and 14 selected high-grade (G2) @entity242 were performed in 42 @entity1 . The hemipelvis was resected and replaced four times, the proximal or distal femur 28 times, the proximal or distal tibia eight times, and the proximal humerus two times. Replacement of an adjacent joint, most commonly using a long-stemmed hip or knee prosthesis, was accomplished in 33 @entity1 . All @entity1 had been followed for a minimum of two years, nine months after treatment. The mean follow-up period is four years, ten months. Six individuals, all with high-grade @entity242 , developed @entity5 -related complications. Two evidenced a local recurrence of @entity5 , and four developed distant @entity3 . None of the @entity1 with low-grade @entity242 developed a recurrence or @entity3 . Fifteen @entity1 suffered complications unrelated to @entity5 control; 13 required reoperation, including two who required amputations for persistent @entity1516 and graft @entity281 , respectively. There was one other @entity281 , successfully eradicated by drainage followed by local and systemic antibiotics. Due to mechanical failure or loosening, six @entity1 were treated by successful revision of their joint arthroplasties. Two years after initial surgery, five @entity1 had failures of union at the graft-host junction. Four healed after cancellous grafting and one was revised to a custom prosthesis. There were no late @entity1642 of the grafts. The technique does not compromise the margins for adequate @entity5 resection. It preserves a graft strong enough to support a joint arthroplasty and to allow early weight-bearing with a low risk of @entity1516 or @entity1642 .
