Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur

Abstract

The use of allograft-prosthesis composites for reconstruction after bone tumor resection at the proximal femur has generated considerable interest since the mid1980s on the basis that their use would improve function and survival, and restore bone stock. Although functional improvement has been documented, it is unknown whether these composites survive long periods and whether they restore bone stock. We therefore determined long-term allograft-prosthesis composite survival, identified major complications that led to revision, and determined whether allograft bone stock could be spared at the time of revision. We also compared the radiographic appearance of allografts sterilized by gamma radiation and fresh-frozen allografts. We retrospectively reviewed 32 patients with bone malignancy in the proximal femur who underwent reconstruction with a cemented allograft-prosthesis composite. The allograft-prosthesis composite was a primary reconstruction for 23 patients and a revision procedure for nine. The minimum followup was 2 months (median, 68 months; range, 2-232 months). The cumulative incidence of revision for any reason was 14% at 5 years (95% confidence interval, 1%-28%) and 19% at 10 years (95% confidence interval, 3%-34%). Nine patients (28%) had revision of the reconstruction during followup; four of these patients had revision surgery for infection. Allografts sterilized by gamma radiation showed worse resorption than fresh-frozen allografts. Based on reported results, allograft-composite prostheses do not appear to improve survival compared with megaprostheses.

Outcome after reconstruction of proximal femoral tumors: A systematic review

“…Limb salvage by tumor resection and subsequent reconstruction is the mainstay of treatment for proximal femoral malignancies. Reconstruction with a (modular or custom) proximal femoral endoprosthesis (tumor prosthesis) or an allograft‐prosthesis composite are the two main alternatives . Other surgical options, such as intramedullary nailing without tumor resection, can be used for palliative treatment in bone metastases .…”

Distal Femoral Osteoarticular Allografts: Long-term Survival, But Frequent Complications

“…Options for restoring a functional lower extremity after wide resection at this site include megaprostheses [2-4, 6, 14-19, 26-30], osteoarticular allografts [2, 5, 10-12, 21-25, 32], and allograftprosthetic composites (APC) [1,16,17,35], each with unique advantages and disadvantages. Osteoarticular allografts offer the potential benefit of biologic bone union, soft tissue attachment, restoration of bone stock, and preservation of the proximal tibial physis in skeletally immature patients.…”

“…They restore bone stock and allow biologic union while providing a stable knee; however, they are technically difficult reconstructions that sacrifice the opposite physis and have some risk of disease transmission, nonunion, and fracture [1,11,16,17,35]. Mankin et al [18] reported good or excellent results in 77% of 98 patients treated with APCs; however, this was an overall rating and results were not reported by anatomic location.…”

Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb

“…21,22 We aimed to reduce the incidence of aseptic loosening by increasing the effective volume of the cavity of the bone to accommodate a prosthetic stem, and at the same time to increase the possibility of using a standard revision prosthesis if required later.…”