The Use of Allografts to Reconstruct Intercalary Defects of Long Bones

Makley, John T.

doi:10.1097/00003086-198507000-00008

Cited by 85 publications

(48 citation statements)

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“…Only one of our patients developed deep infection, requiring a two-stage revision to a new allograft. Rates of infection in other studies of allograft reconstruction range from 6% to 30% [11,17,20], which is similar to or even higher than our rate.…”

Section: Discussionsupporting

confidence: 88%

“…Due to early diagnosis, more accurate imaging techniques, and advanced chemotherapy, many tumors compromising the metadiaphyseal region of long bones can be treated with epiphyseal preservation [18], permitting a better limb function because of the conservation of the proximal and distal joint. These tumor resections originate in segmental bone defects that can be reconstructed using diverse alternatives [1,3,6,14,17,22]. Implantation of intercalary femoral allografts after tumor resection is one biologic option, especially in young and physically active patients who place high demands on the reconstructions.…”

Section: Discussionmentioning

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%

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

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: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Aponte-Tinao

Farfalli

Ritacco

et al. 2012

Clinical Orthopaedics &Amp; Related Research

111

108

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“…Vascularized fibulae have been used to augment arthrodesis reconstructions of all types with overall excellent results [29,31,37,46]. Septic knee arthritis and failed, septic TKA often require débri-dement of large volumes of bone, necessitating structural intercalary segments to maintain limb length when arthrodesis is performed [25]. Autograft, in the form of femoral and fibular strut grafts, was the earliest use of interposition materials [21,24,35].…”

mentioning

confidence: 99%

“…Autograft, in the form of femoral and fibular strut grafts, was the earliest use of interposition materials [21,24,35]. Structural bulk allografts also have been used; however, the union rate is generally lower than those for autograft and failures from infection and fracture are higher [4,10,25,44]. Allograft composites have shown some promise in the medium term, but longer-term followup is required [44].…”

mentioning

confidence: 99%

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Angelini

Henderson

Trovarelli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them. Questions/purposes Our objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap. Methods We present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap.

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Glass–Ceramic implant in acetabular bone defect: An experimental study

Yoshii¹,

Yamamuro²,

Nakamura³

et al. 1992

J of Applied Biomaterials

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Extensive acetabular defects produced surgically in 25 dogs were repaired using A-W glass-ceramic blocks. No dislocation of the femoral head, and no displacement or breakdown of the blocks was seen 1 year after surgery. All dogs were able to run normally shortly after surgery, except for one that limped for a short time. The failure load between the blocks and the bone had increased markedly 2 months after implantation. The failure load/unit area was 33.2 kgw/cm 2 1 year after implantation. We conclude that glass-ceramic supplementation of the acetabulum is successful experimentally, and that this may be a promising method for repair of large acetabular bone defects.

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The Use of Allografts to Reconstruct Intercalary Defects of Long Bones

Cited by 85 publications

References 0 publications

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Glass–Ceramic implant in acetabular bone defect: An experimental study

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