The Principles and Applications of Fresh Frozen Allografts to Bone and Joint Reconstruction

Aponte-Tinao, Luis A.; Ritacco, Lucas E.; Albergo, José I.; Ayerza, Miguel A.; Múscolo, D. Luis; Farfalli, Germán L.

doi:10.1016/j.ocl.2013.12.008

Cited by 37 publications

(26 citation statements)

References 76 publications

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“…Allograft alone is associated with lower union, higher fracture, and higher infection rates. 9 However, in centers with considerable allograft-matching experience and expertise, these factors can be minimized.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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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%

“…Although many papers that analyzed allograft reconstructions described the frequency of infection [1,3,8,9,13], only a few papers analyzed the management of this complication [2,6,7]. Those reports that have analyzed the frequency and treatment of bone allograft infections [2,6,7] did not provide the likelihood of reinfection.…”

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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“…Fresh-frozen allograft have been reported extensively in the literature as a reconstructive option after skeletal tumors resection [11][12][13]. However, in the foot and ankle limited reports on their use have been documented, and we are not aware of a report that focuses only in massive structural allograft in this specific anatomic site [1,4,14,15].…”

Section: Discussionmentioning

confidence: 97%

Structural allograft reconstruction of the foot and ankle after tumor resections

et al. 2016

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The Principles and Applications of Fresh Frozen Allografts to Bone and Joint Reconstruction

Cited by 37 publications

References 76 publications

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

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

Structural allograft reconstruction of the foot and ankle after tumor resections

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