Advertisement

Clinical Orthopaedics and Related Research®

, Volume 470, Issue 3, pp 728–734 | Cite as

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

  • Luis Aponte-TinaoEmail author
  • Germán L. Farfalli
  • Lucas E. Ritacco
  • Miguel A. Ayerza
  • D. Luis Muscolo
Symposium: 2010 Musculoskeletal Tumor Society

Abstract

Background

With the improved survival for patients with malignant bone tumors, there is a trend to reconstruct defects using biologic techniques. While the use of an intercalary allograft is an option, the procedures are technically demanding and it is unclear whether the complication rates and survival are similar to other approaches.

Questions/purposes

We evaluated survivorship, complications, and functional scores of patients after receiving intercalary femur segmental allografts.

Patients and Methods

We retrospectively reviewed 83 patients who underwent an intercalary femur segmental allograft reconstruction. We determined allograft survival using the Kaplan-Meier method. We evaluated patient function with the Musculoskeletal Tumor Society scoring system. Minimum followup was 24 months (median, 61 months; range, 24–182 months).

Results

Survivorship was 85% (95% confidence interval: 93%–77%) at 5 years and 76% (95% confidence interval: 89%–63%) at 10 years. Allografts were removed in 15 of the 83 patients: one with infection, one with local recurrence, and 13 with fractures. Of the 166 host-donor junctions, 22 (13%) did not initially heal. Nonunion rate was 19% for diaphyseal junctions and 3% for metaphyseal junctions. We observed an increase in the diaphysis nonunion rate in patients fixed with nails (28%) compared to those fixed with plates (15%). Fracture rate was 17% and related to areas of the allograft not adequately protected with internal fixation. All patients without complications had mainly good or excellent Musculoskeletal Tumor Society functional results.

Conclusions

Diaphyseal junctions have higher nonunion rates than metaphyseal junctions. The internal fixation should span the entire allograft to avoid the risk of fracture. Our observations suggest segmental allograft of the femur provides an acceptable alternative in reconstructing tumor resections.

Level of Evidence

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

Keywords

Distraction Osteogenesis Nonunion Rate Allograft Failure Musculoskeletal Tumor Society Segmental Bone Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (MPG 3105 kb)

Supplementary material 1 (MPG 5163 kb)

Supplementary material 1 (MPG 12815 kb)

Supplementary material 1 (MPG 11097 kb)

References

  1. 1.
    Abudu A, Carter SR, Grimer RJ. The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Joint Surg Br. 1996;78:652–657.PubMedGoogle Scholar
  2. 2.
    Aldlyami E, Abudu A, Grimer RJ, Carter SR, Tillman RM. Endoprosthetic replacement of diaphyseal bone defects: long-term results. Int Orthop. 2005;29:25–29.PubMedCrossRefGoogle Scholar
  3. 3.
    Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I, Ueda T, Yoshikawa H, Masaki N, Uchida A. Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res. 1999;368:196–206.PubMedCrossRefGoogle Scholar
  4. 4.
    Blunn GW, Briggs TW, Cannon SR, Walker PS, Unwin PS, Culligan S, Cobb JP. Cementless fixation for primary segmental bone tumor endoprostheses. Clin Orthop Relat Res. 2000;372:223–230.PubMedCrossRefGoogle Scholar
  5. 5.
    Canadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis: physeal distraction before excision. J Bone Joint Surg Br. 1994;76:127–132.PubMedGoogle Scholar
  6. 6.
    Capanna R, Campanacci DA, Belot N, Beltrami G, Manfrini M, Innocenti M, Ceruso M. A new reconstructive technique for intercalary defects of long bones: the associations of massive allograft with vascularized fibular autograft: long-term results and comparison with alternative techniques. Orthop Clin North Am. 2007;38:51–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Chang DW, Weber KL. Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg. 2005;116:1918–1925.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen TH, Chen WM, Huang CK. Reconstruction after intercalary resection of malignant bone tumours: comparison between segmental allograft and extracorporeally-irradiated autograft. J Bone Joint Surg Br. 2005;87:704–709.PubMedCrossRefGoogle Scholar
  9. 9.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196.PubMedCrossRefGoogle Scholar
  10. 10.
    Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.PubMedGoogle Scholar
  11. 11.
    Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop Relat Res. 1991;270:181–196.PubMedGoogle Scholar
  12. 12.
    Hanna SA, Sewell MD, Aston WJ, Pollock RC, Skinner JA, Cannon SR, Briggs TW. Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours. J Bone Joint Surg Br. 2010;92:867–874.PubMedCrossRefGoogle Scholar
  13. 13.
    Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res. 2001;382:87–98.PubMedCrossRefGoogle Scholar
  14. 14.
    Hsu RW, Wood M, Sim FH, Chao EY. Free vascularized fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Br. 1997;79:36–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  16. 16.
    Krieg AH, Davidson AW, Stalley PD. Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery. J Bone Joint Surg Br. 2007;89:366–371.PubMedCrossRefGoogle Scholar
  17. 17.
    Makley JT. The use of allografts to reconstruct intercalary defects of long bones. Clin Orthop Relat Res. 1985;197:58–75.PubMedGoogle Scholar
  18. 18.
    Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 2004;86:2686–2693.PubMedGoogle Scholar
  19. 19.
    Muscolo DL, Ayerza MA, Aponte-Tinao L, Ranalletta M, Abalo E. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res. 2004;426:97–102.PubMedCrossRefGoogle Scholar
  20. 20.
    Ortiz-Cruz EJ, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts after resection of tumors: a long-term follow-up study. J Bone Joint Surg Am. 1997;79:97–106.PubMedGoogle Scholar
  21. 21.
    Thompson RC, Pickvance EA, Garry D. Fractures in large segment allografts. J Bone Joint Surg Am. 1993;75:1663–1673.PubMedGoogle Scholar
  22. 22.
    Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S. Limb salvage using distraction osteogenesis: a classification of the technique. J Bone Joint Surg Br. 1997;79:403–411.PubMedCrossRefGoogle Scholar
  23. 23.
    Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am. 1994;76:657–663.PubMedGoogle Scholar
  24. 24.
    Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg. 2004;113:1989–2000.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Luis Aponte-Tinao
    • 1
    Email author
  • Germán L. Farfalli
    • 1
  • Lucas E. Ritacco
    • 1
  • Miguel A. Ayerza
    • 1
  • D. Luis Muscolo
    • 1
  1. 1.Carlos E. Ottolenghi Institute of OrthopedicsItalian Hospital of Buenos AiresBuenos AiresArgentina

Personalised recommendations