Surgical Reconstruction Techniques for Malignant Bone Tumors

Surgical management of malignant bone tumours prioritises limb preservation while ensuring oncological clearance. Reconstruction strategies fall into two broad categories: endoprosthetic replacement and biological reconstruction. Endoprosthetic options include modular intercalary prostheses and custom three-dimensional printed implants, offering immediate structural stability and early mobilisation. Biological approaches encompass autografts (patient’s own bone), allografts (donor bone) and composite grafts combining devitalised tumour bone with vascularised fibular grafts. Techniques for tumour bone devitalisation include liquid-nitrogen freezing, pasteurisation and irradiation to eliminate malignant cells while preserving bone matrix. Vascularised fibular grafts provide intrinsic blood supply and osteogenic potential, particularly advantageous in paediatric patients for growth accommodation. Non-vascularised fibular grafts and massive allografts remain valuable in selected cases, though they may be associated with higher rates of non-union and fracture. Additive manufacturing now enables patient-specific titanium plates and prosthetic segments that conform precisely to resection margins, reducing soft-tissue disruption and improving fixation. Across all methods, optimisation of fixation techniques, rigorous assessment of graft incorporation and multidisciplinary coordination among orthopaedic oncology, radiology and rehabilitation teams are essential. Advances in imaging, computer-assisted design and enhanced biomaterials continue to refine functional outcomes, minimise complications and extend the global applicability of limb-salvage surgery for malignant bone tumours.

Research from Nature Portfolio

Recent clinical series have illustrated the efficacy of modular intercalary prosthetic reconstruction for proximal femoral malignancies, demonstrating rapid postoperative mobilisation, durable fixation without implant loosening and restoration of hip function within months of surgery. Another significant advance involves the integration of three-dimensional printed, patient-specific titanium plates to support bone segments following microwave ablation around the knee. Customised implants, designed from preoperative imaging, have eliminated postoperative fractures and minimised implant failure, yielding functional scores comparable with healthy controls. Both approaches underscore the potential of precision-engineering and modularity to tailor reconstruction to individual anatomy and preserve adjacent joints.

Surgical Reconstruction Techniques for Malignant Bone Tumors publication trend

The graph below shows the total number of articles in surgical reconstruction techniques for malignant bone tumors across all publications each year (not limited to Nature Index journals).

Technical terms

Intercalary reconstruction: Replacement of a segmental bone defect between two healthy bone ends following tumour excision.

Autograft: Bone graft harvested from the patient’s own body to repair a defect.

Allograft: Bone graft obtained from a donor of the same species, processed to remove cellular elements.

Vascularized fibular graft: Transfer of the fibula along with its blood vessels to reconstruct large bone defects and promote biological integration.

Modular intercalary prosthesis: Prefabricated implant composed of adjustable segments that replace resected bone with immediate mechanical stability.

References

1. Graft Survivals after Reconstruction Using Tumor-Bearing Frozen Bone in the Extremities. Cancers (2023).
2. Comparison of survival, function and complication between intercalary frozen autograft versus massive allograft reconstruction after malignant bone tumors resection. Journal of Orthopaedics and Traumatology (2024).
3. Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur. Scientific Reports (2024).
4. 3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee. Scientific Reports (2017).
5. The Vascularized Fibular Graft in the Pediatric Upper Extremity: A Durable, Biological Solution to Large Oncologic Defects. Sarcoma (2013).
6. Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula. Sarcoma (2015).
7. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities. BMC Musculoskeletal Disorders (2017).