Long-Term Clinical Outcomes of Intercalary Allograft Reconstruction for Lower-Extremity Bone Tumors

Abstract

Background: Improved survival rates for patients with primary bone tumors of the extremities have increased the demand for reliable and durable reconstruction techniques. Some authors have stated that, after successful ingrowth, allografts are a durable long-term solution. This hypothesis is largely based on small studies with short-to-midterm follow-up. In order to determine the durability of intercalary allograft reconstructions in the lower extremities, we evaluated the long-term clinical outcomes at a minimum of 10 years. Methods: All patients who received an intercalary allograft reconstruction in a lower extremity between 1980 and 2006 were included in this retrospective multicenter cohort study. One hundred and thirty-one patients with a median age of 19 years were included. Eighty-nine (68%) had a femoral reconstruction, and 42 (32%) had a tibial reconstruction. The most prevalent diagnoses were osteosarcoma (55%), Ewing sarcoma (17%), and chondrosarcoma (12%). The median follow-up was 14 years. A competing risk model was employed to estimate the cumulative incidences of mechanical failure and infection. Patient mortality or progression of the disease was used as a competing event. Results: Nonunion occurred in 21 reconstructions (16%), after a median of 16 months, and was associated with intramedullary nail-only fixation (p < 0.01) and fixation with nonbridging plate(s) (p = 0.03). Allograft fracture occurred in 25 reconstructions (19%) after a median of 42 months (range, 4 days to 21.9 years). Thirteen (52%) of the allograft fractures occurred within 5 years; 8 (32%), between 5 and 10 years; and 4 (16%), at >10 years. With failure for mechanical reasons as the end point, the cumulative incidences of reconstruction failure at 5, 10, and 15 years were 9%, 14%, and 21%, respectively. Conclusions: Intercalary allograft reconstruction is an acceptable reconstructive option, mainly because of the absence of superior alternatives with a known track record. However, a considerable and continuing risk of mechanical complications should be taken into account. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preliminary Results of the “Capasquelet” Technique for Managing Femoral Bone Defects—Combining a Masquelet Induced Membrane and Capanna Vascularized Fibula with an Allograft

“…This criterion was defined by cortical union of at least 75%, as determined on standard X-rays. If the assessment of union was inconclusive on conventional X-rays, the union was assessed using computed tomography (CT) [ 24 ]. Surgical intervention to facilitate union of osseous junctions in Henderson type 2 complications, at least six months after the primary surgery, was defined as non-union [ 25 ].…”

Surgical Advances in Osteosarcoma

“…More recently, a paper published by Sanders et al evaluated the long-term outcomes of allografts for intercalary reconstructions. A total of131 patients (55% OS) were followed for up to minimum of 10 years; infection rates were minimal, but 16% experienced non-union, whilst 19% suffered allograft fractures [135]. Interestingly, fixation with intra-medullary nail only and fixation non-bridging plates were associated with an increased rate of fracture.…”

“…Interestingly, fixation with intra-medullary nail only and fixation non-bridging plates were associated with an increased rate of fracture. Given the complication rates were high, they felt the main reason it was an acceptable method of reconstruction was the lack of alternatives [135]. A similar study by Aponte-Tinao et al also evaluated outcomes for 193 patients (63% OS) over a 10 year period for large allografts.…”

Biology and technology in the surgical treatment of malignant bone tumours in children and adolescents, with a special note on the very young

“…18 An update with long-term results was recently published for intercalary allograft reconstruction, an acceptable reconstructive option but with a considerable mechanical complication risk. 19 , 20 Complications included nonunion and allograft fracture, and to reduce risk of failure, bridging plate fixation is advised. With use of virtual planning and 3D-printed saw jigs, customized structural allografts can also be used for correction of alignment after growth disturbance in for example Ollier’s disease.…”