Why choose biological over endoprosthesis?
- Bone remodelling: the graft integrates and remodels into host bone.
- No wear: no metal articulating surfaces to wear out.
- Joint preservation: intercalary reconstructions spare native joints.
- Growth potential: autografts can hypertrophy and adapt — crucial in children.
Biological reconstruction in real patients
Watch how grafts and recycled bone are used across different scenarios — from benign tumours to complex wrist reconstructions and paediatric flat-bone tumours.
Allograft & autograft for benign bone tumour
How donor bone (allograft) and the patient's own bone (autograft) are used to fill the cavity left after curettage of a benign bone tumour — restoring strength and shape.
Using patient's own bone in same limb — transposition or translocation such as cancers around wrist
Reconstruction around the wrist after tumour resection by translocating the patient's own neighbouring bone within the same limb — using living, vascularised tissue to recreate the joint and restore function.
Recycling flat bones in very young children
For very young patients with tumours of flat bones (pelvis, scapula), the involved bone segment can be sterilised and reimplanted — preserving anatomy and growth potential.
How intercalary reconstruction is performed
- Tumour resection leaving healthy bone above and below the joints.
- Graft selection: non-vascularised fibula for < 10 cm defects; vascularised fibula for > 10 cm or poor host bone; size-matched allograft fixed with plates or nails; or a 3D-printed custom spacer combined with bone graft.
- Fixation with a locking plate or intramedullary nail.
- Biological healing — autograft union in 6–9 months, allograft union in 9–12 months.
Studies report 5-year graft survival of 72–85% and union rates above 80% for vascularised fibula autografts.
Arthrodesis — when fusion is the right answer
Arthrodesis fuses a joint by bridging the defect with graft and metal fixation. It suits patients with heavy labour demands, upper-limb joints where motion is less critical, or after failed reconstructions. Lower-limb fusion achieves walking stability with 2–3 cm shortening; upper-limb fusion preserves pinch and reach.
Recycled tumour autograft (ECRT) and cryotherapy
- Extracorporeal irradiated autograft (ECRT): tumour-bearing bone is irradiated (50 Gy) ex vivo and reimplanted — union rate 85%, local recurrence < 2%.
- Cryotherapy (liquid nitrogen): the tumour-bearing segment is frozen, thawed and reimplanted — union rate 90%, recurrence < 2%.
Irradiation & reimplantation of sarcoma-bearing bone
The tumour-affected bone is removed, sterilised with a high dose of radiation outside the body (ECRT), and reimplanted as a perfectly shape-matched biological graft — combining oncological safety with anatomic restoration.
Recycling flat bones in very young children
For pelvic and scapular tumours in young children, the resected segment can be recycled and reimplanted — preserving native anatomy and growth potential where implants would otherwise be unsuitable.
See ECRT and bone recycling in action
Watch how we sterilise and reimplant the patient's own tumour-bearing bone — restoring anatomy while eliminating cancer cells.
How we use patient's own bone to recycle, kill tumour with irradiation and reimplant it back
The involved bone is removed, treated with a high dose of radiation to destroy all tumour cells, and then placed back — giving the patient their own anatomy with oncological safety.
Recycling of flat bones in young children and saving joint movements
In very young patients with flat bone tumours, the recycled bone segment is reimplanted to preserve native anatomy, growth potential and joint function.
Allograft options
- Massive allograft — structural support for large defects; ~60% 10-year survival.
- Osteoarticular allograft — donor bone replaces the joint surface; cartilage degeneration is notable by 5–10 years.
- Morselised cancellous graft — fills small cavitary defects and accelerates host healing.
3D-printed and patient-specific solutions
Custom titanium implants with porous surfaces are matched exactly to your anatomy and promote osseointegration. Patient-specific instrumentation (PSI) guides precise cuts and implant placement, and hybrid techniques combine a 3D spacer with biological graft. Early series report 95% union at 6 months and functional scores above 85% with no device-related failures at 2 years.
Complications to watch for
- Nonunion or delayed union 10–20% — managed with bone stimulators or revision grafting.
- Graft fracture 5–10% — risk reduced with plate augmentation.
- Infection 5–12% — debridement and prolonged antibiotics.
- Graft resorption 5–8% over 5 years — usually clinically silent.
- Donor-site morbidity (autograft) — ankle instability or pain after fibula harvest.
Take-home summary
Biological reconstruction offers long-lasting, joint-sparing solutions using autografts, allografts, recycled tumour bone, and custom 3D-printed implants. Careful patient selection, precise surgical technique and multidisciplinary care yield > 80% union and durable functional preservation with manageable complication rates.
References
- PMC7315319 — Epidemiological study of adamantinoma (methodology applicable to ECRT), 2020.
- PMC2947697 — Late complications and survival of endoprosthetic reconstruction (comparative context), 2010.
- PMC9561186 — Application of 3D printing implants for bone tumours, 2021.
- PMC10233802 — 3D printing for patient-specific implants in musculoskeletal oncology, 2023.
- PMC4209493 — Use of megaprostheses for large skeletal reconstructions — outcomes, 2014.
- PMC8627749 — Extracorporeal irradiated autograft reconstruction outcomes.