Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Abstract

Aim:The biological reconstruction of the knee with osteoarticular allografts and resection arthrodesis have been reported but there has not yet been a direct comparison between both these procedures. This study aimed to identify the prognostic factors that influence failure of biological reconstruction and compared the results between both procedures.Methods: Between 1994 and 2017, we performed 92 limb-sparing procedures using resection arthrodesis (n = 53) and osteoarticular allograft reconstruction (n = 39) for the management of primary bone tumors around the knee. The minimum follow-up time was 2 years in both groups. Results:The failure rate of reconstruction in the osteoarticular allograft and resection arthrodesis group was 48.7% and 39.6%, respectively (p = 0.75). The mean MSTS score in the osteoarticular allograft and resection arthrodesis group was 23.7 and 21.8, respectively (p = 0.01). The significant risk factor for failure after biological reconstruction was the administration of chemotherapy (p = 0.001; HR = 3.39; 95% CI, 1.60-7.17). Conclusion:Patients who underwent osteoarticular allograft had a better functional outcome than those who underwent resection arthrodesis reconstruction, but clinical outcomes between the groups were comparable. Chemotherapy is a significant adverse prognostic factor for failure of biological reconstruction.

Recycled bone grafts treated with extracorporeal irradiation or liquid nitrogen freezing after malignant tumor resection

“…The higher infection rate in the ECIR group may be explained by factors unrelated to the cell eradication technique such as a higher proportion of patients undergoing chemotherapy for Ewing sarcoma or osteosarcoma, the anatomical location posing a higher risk (e.g., tibia or pelvis), or the reconstructive technique (requiring the presence of a prosthesis or use of VFG or not). Recycled bones with VFG are expected not only from host bones but also from free VFG 5,6 . Therefore, VFG may play a role in reducing complications that include infection.…”

“…Recycled bones with VFG are expected not only from host bones but also from free VFG. 5,6 Therefore, VFG may play a role in reducing complications that include infection. In a previous study with VFG reconstruction alone after tumor resection, among 49 cases, infection was reported for three cases (6%), and nonunion in five cases (10%).…”

“…Musculotendinous attachments can be preserved. 5,6 Several cytocidal procedures have been used for the preparation of recycled bone autografts which include autoclaving, pasteurization, extracorporeal irradiation (ECIR), and liquid nitrogen-freezing (LNF). 4,7,8 Graft-derived tumor recurrence is a most serious complication because it can affect patients' life prognosis.…”

“…Bone matrices with extinct cells are expected to be remodeled into vital bone tissue via the ingrowth of surrounding healthy bone tissue from host bone or vascularized bone grafts. Musculotendinous attachments can be preserved 5,6 …”