Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Abstract

Background With the improved survival for patients with malignant bone tumors, there is a trend to reconstruct defects using biologic techniques. While the use of an intercalary allograft is an option, the procedures are technically demanding and it is unclear whether the complication rates and survival are similar to other approaches. Questions/purposes We evaluated survivorship, complications, and functional scores of patients after receiving intercalary femur segmental allografts. Patients and Methods We retrospectively reviewed 83 patients who underwent an intercalary femur segmental allograft reconstruction. We determined allograft survival using the Kaplan-Meier method. We evaluated patient function with the Musculoskeletal Tumor Society scoring system. Minimum followup was 24 months (median, 61 months; range, 24-182 months).Results Survivorship was 85% (95% confidence interval: 93%-77%) at 5 years and 76% (95% confidence interval: 89%-63%) at 10 years. Allografts were removed in 15 of the 83 patients: one with infection, one with local recurrence, and 13 with fractures. Of the 166 host-donor junctions, 22 (13%) did not initially heal. Nonunion rate was 19% for diaphyseal junctions and 3% for metaphyseal junctions. We observed an increase in the diaphysis nonunion rate in patients fixed with nails (28%) compared to those fixed with plates (15%). Fracture rate was 17% and related to areas of the allograft not adequately protected with internal fixation. All patients without complications had mainly good or excellent Musculoskeletal Tumor Society functional results. Conclusions Diaphyseal junctions have higher nonunion rates than metaphyseal junctions. The internal fixation should span the entire allograft to avoid the risk of fracture. Our observations suggest segmental allograft of the femur provides an acceptable alternative in reconstructing tumor resections.

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

“…However, it is too early to determine if these results will hold up with longer followup. At short-term followup, the nonunion and infection rates appear lower than previously reported [1,7,12].…”

“…However, we found a lower nonunion rate (6%) if we compare our series with previous reports that show nonunion rates of more than 10% [1,6,12]. Nonunions are frequently related to the accuracy of the osteotomies performed at the hostallograft junctions.…”

“…The complications reported in this series did not differ from the expected in this kind of surgery [1,6,12]. However, we found a lower nonunion rate (6%) if we compare our series with previous reports that show nonunion rates of more than 10% [1,6,12].…”

Surgical Revascularization in Structural Orthotopic Bone Allograft Increases Bone Remodeling

“…Cryopreserved allografts frequently are used to restore defects after tumor resection, bone infection, and trauma [2]. Unfortunately, allografts are associated with a high rate of complications, including infection, nonunion, and fracture [7,8,12,18,19].…”

“…The use of cryopreserved allogeneic bone has been a widely used and appropriate alternative to reconstruct segmental defects [2]. However, a serious shortcoming of bone allograft is the high frequency of complications such as infection, fracture, and nonunion [4,12,14,26].…”