Presentation in biological reconstruction options in Orthopaedic Oncology

1. Dr Srinath Gupta
MS (Ortho), HBNI Fellow - Ortho Onco
(Tata Memorial Hospital, Mumbai)
Consultant Orthopaedic Oncosurgeon

2. Reconstruction options
Malignant bone tumors

3. Case 1

4. • 16 Years/M
• Non metastatic osteosarcoma of distal femur

5. Management
• Osteosarcoma
NACT

6. Post chemo

12. Various megaprosthesis

13. Total femur megaprosthesis

14. Proximal humerus Megaprosthesis

15. Proximal humerus
Reverse shoulder prosthesis

16. Distal humerus megaprosthesis

17. Proximal tibia megaprosthesis

18. Megaprosthesis

19. Disadvantages of a Megaprosthesis

21. New car

22. Biological reconstruction

23. • Vascularized fibula graft
• Tumor bone sterilization

24. Vascularized fibula

25. Tumor bone sterilization
• ExtraCorporeal Radiotherapy (ECRT)
• Cryotherapy – Liquid nitrogen

26. Case 2

27. 31yr/Male

29. Biopsy

30. Surgical planning

33. Incision

34. Separation of the NVB

35. Jig placement

36. Post resection

37. Specimen

40. Post Op Xray F/U - 8 months

41. Post Op Xray F/U - 8 months

42. Case 3

43. Reconstruction in paediatric age
groups

44. • Expandable prosthesis
– Invasive or
– Non invasive
• Physis sparing resection

45. Case 3

46. • 12yr/Boy
• Non metastatic Ewing’s sarcoma – Left femur
diaphysis

47. Pre - chemotherapy

48. Post-chemotherapy

49. Resection levels

50. Pre-op planning – 3D
Goals
To avoid distal physis
Stable fixation

51. 3D printed – Titanium plate, cutting
guide and bone model

55. Post – op radiograph

56. 24 months – Post Op

57. Case 4

58. • 14yr/Female
• Osteosarcoma of proximal tibia

59. Post chemo - MRI

60. Planning

65. Post Op Follow - up

66. 20yr/Male
Osteosarcoma – Femur diaphysis

68. 8yr/Female

69. Biological reconstruction
• In all cases where the joint can be saved
• In osteoarticular resections – Megaprosthesis
is still the treatment of choice

70. Thank You!