Massive allografts in tumour surgery

Abstract

We offer our personal experience of the use of massive bone allografts after tumour resection. We demonstrate the long-term results from 71 patients (72 allografts) operated on between 1961 and 1990. The long-term survival rate in osteoarticular and intercalary grafts is around 60%. Fractures of the graft can be salvaged in most cases. Infection leads to the removal of the graft in almost all cases. Factors influencing the survival, remodelling and complications of the grafts are discussed. The regime of cryopreservation, fixation and loading of the graft influence these factors, as do the use of autologous bone chips around the allograft-host junction and the application of chemotherapy or radiation. Fracture of the graft can be salvaged in most cases, as opposed to infection which remains the most severe complication and can occur at any time. Even with the improvement of tumour endoprostheses, the use of allografts remains an option, especially in young patients. Résumé Les auteurs rapportent leur expérience de l'utilisation des allogreffes massives après résection tumorale.Les résultats à long terme de 71 patients (73 allogreffes) opérés entre 1961 et 1990 sont rapportés avec un taux de survie dans les greffes articulaires et intercalaires voisin de 60%. Les fractures de greffes peuvent être rattrapées dans de nombreux cas, mais l'infection conduit à retirer la greffe dans la plupart des cas. Les facteurs influençant le remodelage et les complications des allogreffes sont discutés. Le régime de cryopréservation, la fixation et la remise en contrainte des greffes influencent ces facteurs ainsi que la disposition de lamelles d'autogreffe à la jonction hôte-allogreffe et l'aexistence de radio ou chimiothérapie. La rupture de la greffe peut être récupérée dans la plupart des cas, contrairement à l'infection qui demeure la complication la plus grave qui peut se produire à tout moment. Même avec le développement des prothèses massives pour tumeur l'utilisation des allogreffes reste une option interessante spécialement chez les patients jeunes.

Reconstruction of distal radius by fibula following excision of grade III giant cell tumour: Follow-up of 18 cases

“…Some have reported that 16 out of 24 patients (67%) suffered local recurrence within the first two years, six (25%) suffered recurrence between two and five years later and two (8.3%) suffered recurrence more than five years later. Therefore, postoperative follow-up examinations of GCT patients are essential for at least the first five years [11][12][13][14], as recommended by Eckardt and Grogan [5,7,12].…”

“…While single extended curettage performed carefully by an experienced orthopaedic oncologist offers a good chance of eliminating the disease, the results are not so predictable in aggressive grade III tumours [4,13,14]. We recommend that treatment with curettage for grade I and II giant cell tumours offers a very good (90%) chance of cure.…”

Custom prosthetic replacement for distal radial tumours

“…Complications include nonunion, fractures, slow incorporation of the allograft and possibility of transmitting infectious diseases [11,17]. Furthermore, allografts are not easily procurable in most countries.…”

Custom-made endoprosthetic total humerus reconstruction for musculoskeletal tumours

“…The use of allografts, alloprosthetic composites and prosthetic replacements to reconstruct the proximal humerus after tumour resection and associated complications have been well described [5][6][7][8][9]11]. However, extensive tumours of the humerus, large tumours of the diaphysis and local recurrent disease after limb-salvage surgery present unique problems with respect to reconstruction options.…”