Long-Term Results of Allograft Replacement in the Management of Bone Tumors

Mankin, Henry J.; Gebhardt, Mark C.; Jennings, L.; Springfield, Dempsey S.; Tomford, William W.

doi:10.1097/00003086-199603000-00011

Cited by 609 publications

(460 citation statements)

References 28 publications

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“…Endoprosthetic reconstructions replace the native articular surface of the knee with a prosthetic implant that has a higher failure rate than conventional arthroplasty of the knee [22,28]. CS procedures preserve the native articular surface and avoid the need for arthroplasty of the knee with a possible increase in local recurrence and graft healing complications [21,24]. Comparison of these two techniques reflects the decisions tumor surgeons face: the decision to provide adequate surgical margins to prevent local recurrence while salvaging enough bone to preserve longevity and function of the affected limb.…”

Section: Discussionmentioning

confidence: 99%

“…The complications for this reconstruction option are aseptic loosening (3%-40%), infection (3%-28%), and mechanical wear/prosthetic or component fracture (1%-67%) [2,6,8,12,13,15,19,27,30,33]. Intercalary allografts offer a joint-sparing reconstructive option, but nonunion, delayed union, infection, and graft fractures are well-described complications [20,21,23,24].…”

Section: Introductionmentioning

confidence: 99%

“…These few studies about the condyle-sparing or epiphyseal preservation technique have been case reports or series with less than 20 patients [4,23] but raise concerns regarding the adequacy of surgical margins and the risk of local recurrence when preserving the distal femoral condyle [23]. The rate of local recurrence for published series on endoprosthestic reconstruction ranges from as low as ''none reported'' to as high as 6%, whereas the rate in the allograft literature ranges from 4% to 10% [1,6,15,19,21,27,33]. However, given the variations in the reports, it remains unclear whether the local recurrence rate or revision rate differs for endoprosthetic and condyle-sparing reconstruction.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups. We retrospectively reviewed 85 patients (mean age, 22 years; range, 4-82 years), 38 (45%) of whom had a condyle-sparing allograft and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2-19 years). Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having allografts. Using time to local recurrence as an end point, the Kaplan-Meier

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Although prosthetic reconstructions have improved in recent years, biological reconstruction is a functional alternative option for large extremity osseous defects [1,3,8,9]. Fresh-frozen allografts have been used for many years as a reconstruction option for large bony defects of the pelvis and extremity [1].…”

Section: Introductionmentioning

confidence: 99%

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Aponte-Tinao

Ayerza

Múscolo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important. Questions/purposes The purposes of this study were (1) to analyze the frequency of infection in a group of patients treated with massive bone allografts; (2) to analyze risk factors such as age, sex, affected bone, type of reconstruction, operative room used, primary or revision procedure, length of postoperative antibiotic administration, and use of chemotherapy; and (3) to determine the likelihood that treatment of an infected allograft will result in a successful reconstruction.Methods We retrospectively analyzed the records of patients treated with massive bone allografts for a benign or malignant bone tumor or as a revision for a previous limb salvage procedure between 1985 and 2011. During this period, 673 patients were reconstructed with massive bone allografts in long bones, which included 272 osteoarticular, 246 intercalary, and 155 allograft-prosthetic composite reconstructions. Using a chart review, we ascertained the frequency of infection and reoperations after the treatment of infected allografts. Minimum followup was 2 years unless death occurred earlier (mean, 106 months; range, 6-360 months), and no patient was lost to followup. The selected variables were analyzed using multivariate logistic regression to identify risk factors for infection. We analyzed survivorship free of infection as the endpoint. Results During followup, 60 patients (9%) had a bacterial infection of the allograft with a survivorship free from infection of 92% at 5 years (95% confidence interval [CI], 90%-94%) and 91% at 10 years (95% CI, 89%-93%). We found that tibia allografts (p\0.001; odds ratio [OR], 3.17; 95% CI, 1.80-5.60), male patients (p \ 0.029; OR, 1.92; 95% CI, 1.08-3.49), procedures performed in a conventional operating room (p \ 0.002; OR, 3.15; 95% CI, 1.58-6.62), and the use of longer periods of postoperative antibiotics (p \ 0.041; OR, 2.25; 95% CI, 1.02-4.88) were patient factors associated with a greater risk of infection. In 11 patients (18%, 11 of 60 infections) the infection was controlled with antibiotics and surgical débridement; however, in 49 patients (82%, 49 of 60 infections), this approach failed, so the allograft was removed and a temporary cement spacer with antibiotic was implanted to control the infection. Forty-one patients subsequently had the spacer removed and were reconstructed after infection control with another bone allograft in 24 and an endoprostheses in 17. Four patients underwent an amputation

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“…Several reconstruction approaches are employed to provide a functional and durable extremity. Although initial studies confirm that limb-salvage surgery carries no greater risk of local recurrence or mortality compared with amputation [6], complications are common, and concerns about late revisions in this patient population remain [4]. Skeletal reconstruction with prosthetic components, large-allograft bone segments, autograft techniques, free fibula transfers, and novel autograft procedures (such as the ''turn-downplasty'' knee arthrodesis [9]) all have had some success.…”

mentioning

confidence: 99%

CORR Insights®: Is the Induced-membrane Technique Successful for Limb Reconstruction After Resecting Large Bone Tumors in Children?

Nicholas

2015

Clinical Orthopaedics &Amp; Related Research

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Long-Term Results of Allograft Replacement in the Management of Bone Tumors

Cited by 609 publications

References 28 publications

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

CORR Insights®: Is the Induced-membrane Technique Successful for Limb Reconstruction After Resecting Large Bone Tumors in Children?

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