Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections

Múscolo, D. Luis; Ayerza, Miguel A.; Aponte-Tinao, Luis A.; Ranalletta, Maximiliano; Abalo, Eduardo

doi:10.1097/01.blo.0000141652.93178.10

Cited by 158 publications

(149 citation statements)

References 18 publications

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“…We did observe a difference in nonunion rate comparing diaphyseal with metaphyseal osteotomies. This event is also described in a previous publication [19] and may be related to the better consolidation rate observed in metaphyseal bone. Only one of our patients developed deep infection, requiring a two-stage revision to a new allograft.…”

Section: Discussionsupporting

confidence: 80%

“…Vander Griend [23] reported plate fixation was associated with a higher rate of fracture of the allograft. In a previous report [19], we suggested the risk of fracture may be diminished by spanning the entire allograft with a long plate to provide extracortical support. In this study, most fractures were located at the distal femur metaphysis and were related to areas not covered by the internal fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Due to early diagnosis, advanced chemotherapy, and accurate preoperative imaging techniques, many tumors involving the metadiaphyseal region of long bones currently can be treated with epiphyseal preservation [19]. The tumor en bloc resections originate in segmental bone defects that represent a challenging reconstructive problem.…”

Section: Introductionmentioning

confidence: 99%

“…The tumor en bloc resections originate in segmental bone defects that represent a challenging reconstructive problem. Surgical options for reconstructing metadiaphyseal defects include biologic reconstructions (ie, not using megaprostheses), such as autogenous vascularized fibular grafts [7,14,24], autogenous extracorporeally irradiated bone [3,8,16], segmental bone transportation or distraction osteogenesis [5,22], massive allograft [17,19,20], and the combination of massive allograft with autogenous vascularized fibular grafts [6]. Nonbiologic reconstructions, on the other hand, use intercalary endoprostheses [1,2,4,12].…”

Section: Introductionmentioning

confidence: 99%

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Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Aponte-Tinao

Farfalli

Ritacco

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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111

108

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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.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Aponte-Tinao

Farfalli

Ritacco

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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111

108

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“…However, nonunions were detected in all experimental groups, suggesting that despite these variables, detectable nonunions do occur. With an overall nonunion rate of 7.7% (four of 52 junctions), the model produced a nonunion rate similar to that in a human clinical report [42]. Furthermore, the model shows a trend toward nonunions at the proximal ends of the graft-host interface, which is more diaphyseal in location, more often than at the distal end of the graft-host interface, which is more metaphyseal in location, a phenomenon that is mirrored in humans.…”

Section: Discussionsupporting

confidence: 65%

Effects of a New Allograft Processing Procedure on Graft Healing in a Canine Model: A Preliminary Study

Beebe

Benevenia

Tuy

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Graft healing in vivo can be affected by allograft processing. We asked whether a new processing technique influenced graft-host healing compared with autograft and a standard processing technique in a canine ulna model. We used bilateral intercalary allografts or autografts in the ulna of 13 skeletally mature male coonhounds. Each animal received two allografts, either one autograft and one allograft, or two autografts. At term (90 days), the graft sites were harvested. We assessed union with high-resolution xray imaging. Each specimen was processed for nondecalcified histologic analysis to assess the graft-host interface. Quantitative histomorphometric analysis was performed to determine spatial location and area of bone. Radiographic analysis, histologic analysis, and histomorphometric measures revealed no differences in union, mean total bone area, or total endosteal/intramedullary bone for the new process, standard process, and autografts. Our preliminary data suggest the new processing techniques may increase the safety of allograft transplantation without adversely affecting union when compared with standard processing techniques and autograft in a canine model.

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A review of biomimetic scaffolds for bone regeneration: Toward a cell‐free strategy

Jiang

Wang

2020

Bioengineering & Transla Med

110

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In clinical terms, bone grafting currently involves the application of autogenous, allogeneic, or xenogeneic bone grafts, as well as natural or artificially synthesized materials, such as polymers, bioceramics, and other composites. Many of these are associated with limitations. The ideal scaffold for bone tissue engineering should provide mechanical support while promoting osteogenesis, osteoconduction, and even osteoinduction. There are various structural complications and engineering difficulties to be considered. Here, we describe the biomimetic possibilities of the modification of natural or synthetic materials through physical and chemical design to facilitate bone tissue repair. This review summarizes recent progresses in the strategies for constructing biomimetic scaffolds, including ion‐functionalized scaffolds, decellularized extracellular matrix scaffolds, and micro‐ and nano‐scale biomimetic scaffold structures, as well as reactive scaffolds induced by physical factors, and other acellular scaffolds. The fabrication techniques for these scaffolds, along with current strategies in clinical bone repair, are described. The developments in each category are discussed in terms of the connection between the scaffold materials and tissue repair, as well as the interactions with endogenous cells. As the advances in bone tissue engineering move toward application in the clinical setting, the demonstration of the therapeutic efficacy of these novel scaffold designs is critical.

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Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections

Cited by 158 publications

References 18 publications

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Effects of a New Allograft Processing Procedure on Graft Healing in a Canine Model: A Preliminary Study

A review of biomimetic scaffolds for bone regeneration: Toward a cell‐free strategy

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