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Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

The use of allograft-prosthesis composites for reconstruction after bone tumor resection at the proximal femur has generated considerable interest since the mid1980s on the basis that their use would improve function and survival, and restore bone stock. Although functional improvement has been documented, it is unknown whether these composites survive long periods and whether they restore bone stock. We therefore determined long-term allograft-prosthesis composite survival, identified major complications that led to revision, and determined whether allograft bone stock could be spared at the time of revision. We also compared the radiographic appearance of allografts sterilized by gamma radiation and fresh-frozen allografts. We retrospectively reviewed 32 patients with bone malignancy in the proximal femur who underwent reconstruction with a cemented allograft-prosthesis composite. The allograft-prosthesis composite was a primary reconstruction for 23 patients and a revision procedure for nine. The minimum followup was 2 months (median, 68 months; range, 2–232 months). The cumulative incidence of revision for any reason was 14% at 5 years (95% confidence interval, 1%–28%) and 19% at 10 years (95% confidence interval, 3%–34%). Nine patients (28%) had revision of the reconstruction during followup; four of these patients had revision surgery for infection. Allografts sterilized by gamma radiation showed worse resorption than fresh-frozen allografts. Based on reported results, allograft-composite prostheses do not appear to improve survival compared with megaprostheses.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Drs. L. Vastel and B. Bourely (Hôpital Cochin, Bone Bank) for help with preparation of the manuscript, and Dr. E. Pluot for evaluating the postoperative radiographs as the second senior radiologist. Unidentified patient level data are available by request to promote and facilitate research on rare diseases.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hôpital Cochin, Université Paris Descartes, AP-HP, Service d’orthopedie et traumatologie B, 27 rue du Faubourg Saint-Jacques, Paris Cedex 14, 75679, France

    David J. Biau MD & Philippe Anract MD

  2. Department of Biostatistics and Clinical Epidemiology, Hôpital Saint Louis, INSERM–UMR-S 717, Université Paris Diderot, AP-HP, Paris, France

    David J. Biau MD

  3. Department of Pathology, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France

    Frédérique Larousserie MD

  4. Department of Radiology, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France

    Fabrice Thévenin MD

  5. Department of Oncology, Institut Curie, Paris, France

    Sophie Piperno-Neumann MD

Authors
  1. David J. Biau MD
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  2. Frédérique Larousserie MD
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  3. Fabrice Thévenin MD
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  4. Sophie Piperno-Neumann MD
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  5. Philippe Anract MD
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Correspondence to David J. Biau MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at Hôpital Cochin.

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Biau, D.J., Larousserie, F., Thévenin, F. et al. Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur. Clin Orthop Relat Res 468, 834–845 (2010). https://doi.org/10.1007/s11999-009-1132-z

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  • DOI: https://doi.org/10.1007/s11999-009-1132-z

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