Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur
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.
- 3.American Society of Anesthesiologists. New classification of physical status. Newsletter of the American Society of Anesthesiologists. Anesthesiology. 1963;24:111.Google Scholar
- 4.Anract P, Coste J, Vastel L, Jeanrot C, Mascard E, Tomeno B. [Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite: a comparative study of functional results, complications and longevity in 41 cases] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2000;86:278–288.PubMedGoogle Scholar
- 15.Fletcher CDM, Unni KK, Merten SF (eds). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon, France: IARC Press; 2002.Google Scholar
- 25.Langlais F, Tomeno B (eds). Limb Salvage: Major Reconstructions in Oncologic and Nontumoral Conditions. Heidelberg, Germany: Springer; 1991.Google Scholar
- 36.Penel N, Yazdanpanah Y, Chauvet MP, Clisant S, Giard S, Neu JC, Lefebvre D, Fournier C, Bonneterre J. Prevention of surgical site infection after breast cancer surgery by targeted prophylaxis antibiotic in patients at high risk of surgical site infection. J Surg Oncol. 2007;96:124–129.CrossRefPubMedGoogle Scholar
- 38.R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2006. Available at: www.R-project.org. Accessed May 13, 2009.