Complications following allograft reconstruction for primary bone tumors: Considerations for management

Ippolito, Joseph A.; Martinez, Maximilian; Thomson, Jennifer E.; Willis, Alexander R.; Beebe, Kathleen S.; Patterson, Francis; Benevenia, Joseph

doi:10.1016/j.jor.2018.12.013

Cited by 14 publications

(11 citation statements)

References 52 publications

(92 reference statements)

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“…In addition, post-operative chemotherapy lowers the success rate of biological reconstructions as the adverse effect on bone healing and is associated with high rates of fracture and infection. 27 At this condition, prosthetic reconstruction with rigid biological fixation from 3D-printed porous implant may be one of the solutions. Thus, we set the length of intercalary tibial defects over 15.0 cm or 60% of tibia as the first essential condition of an "ultra-critical sized bone defect".…”

Section: Discussionmentioning

confidence: 99%

<p>Intercalary Reconstruction of the “Ultra-Critical Sized Bone Defect” by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor</p>

Zhao

Tang

et al. 2020

CMAR

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This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" following intercalary tibial tumor resections. Methods: This study defined an "ultra-critical sized bone defect" in the tibia when the length of segmental defect in the tibia was >15.0 cm or >60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with "ultra-critical sized bone defects" following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated. Results: Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm-3.8cm). The mean follow-up time was 27.6 months (range=14.0-62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone-porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed. Conclusion: Reconstruction of the "ultra-critical sized bone defect" after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" in the tibia.

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Section: Discussionmentioning

confidence: 99%

<p>Intercalary Reconstruction of the “Ultra-Critical Sized Bone Defect” by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor</p>

Zhao

Tang

et al. 2020

CMAR

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“…Graft survival was analyzed using the Kaplan–Meier survival analysis, and differences in survival between groups were compared using the log-rank test. The following variables were included in the study as independent risk factors: age 16 , 17 , sex 16 , 18 , tumor location 14 , 16 , 19 , graft length 17 , chemotherapy 5 , 16 , 20 , and method of reconstruction 17 . The independent risk factors for failure of biological reconstruction were determined using the Cox proportional hazards regression model.…”

Section: Discussionmentioning

confidence: 99%

Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction

Wisanuyotin

Paholpak

Sirichativapee

et al. 2022

Sci Rep

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There have been no studies comparing the outcomes of nonvascularized autograft (NA) and allograft after resection of primary bone tumors. This study compares the clinical, functional outcomes of NA and allograft reconstruction and analyzes the risk factors for failure after these procedures. A retrospective study of patients with primary bone tumors of the extremities who underwent NA (n = 50) and allograft reconstruction (n = 47). The minimum follow up time was 24 months. The mean time to union for the NA and allograft group was 9.8 ± 2.9 months and 11.5 ± 2.8 months, respectively (p = 0.002). Reconstruction failure in the NA and allograft group was 19 (38%) and 26 (55.3%), respectively. Nonunion (30%) was the most common complication found in the NA group, while structural failure (29.8%) was the most common in the allograft group. There was no significant difference in functional outcome in terms of the mean Musculoskeletal Tumor Society score between the NA and allograft groups (23.5 ± 2.8 and 23.9 ± 2.1, respectively, p = 0.42). Age, sex, tumor location, graft length, method of reconstruction did not significantly influence failure of reconstruction. Chemotherapy was the only significant risk factor affecting outcomes (HR = 3.49, 95% CI = 1.59–7.63, p = 0.002). In the subgroup analysis, the use of chemotherapy affected graft-host nonunion (p < 0.001) and structural failure in both the NA and allograft groups (p = 0.02). Both NA and allograft reconstruction methods provide acceptable clinical and functional outcomes. Chemotherapy is a risk factor for failure of both reconstructions, particularly graft-host nonunion and structural failure.

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“…The log-rank test was used to compare survival between groups. The risk factors for failure of biological reconstruction from previous studies (age, 13,15-18 sex, 18,19 tumor location, 6,15,18,20,21 graft length, 15,16 chemotherapy, 13,16,18,21 type of reconstruction 16,19 ) were included in this study as independent prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Wisanuyotin

Paholpak

Sirichativapee

et al. 2021

Asia-Pac J Clncl Oncology

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Aim:The biological reconstruction of the knee with osteoarticular allografts and resection arthrodesis have been reported but there has not yet been a direct comparison between both these procedures. This study aimed to identify the prognostic factors that influence failure of biological reconstruction and compared the results between both procedures.Methods: Between 1994 and 2017, we performed 92 limb-sparing procedures using resection arthrodesis (n = 53) and osteoarticular allograft reconstruction (n = 39) for the management of primary bone tumors around the knee. The minimum follow-up time was 2 years in both groups. Results:The failure rate of reconstruction in the osteoarticular allograft and resection arthrodesis group was 48.7% and 39.6%, respectively (p = 0.75). The mean MSTS score in the osteoarticular allograft and resection arthrodesis group was 23.7 and 21.8, respectively (p = 0.01). The significant risk factor for failure after biological reconstruction was the administration of chemotherapy (p = 0.001; HR = 3.39; 95% CI, 1.60-7.17). Conclusion:Patients who underwent osteoarticular allograft had a better functional outcome than those who underwent resection arthrodesis reconstruction, but clinical outcomes between the groups were comparable. Chemotherapy is a significant adverse prognostic factor for failure of biological reconstruction.

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Complications following allograft reconstruction for primary bone tumors: Considerations for management

Cited by 14 publications

References 52 publications

<p>Intercalary Reconstruction of the “Ultra-Critical Sized Bone Defect” by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor</p>

<p>Intercalary Reconstruction of the “Ultra-Critical Sized Bone Defect” by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor</p>

Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

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