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Pasteurized autograft–prosthesis composite for proximal femoral reconstruction: an alternative to allograft composite

Archives of Orthopaedic and Trauma Surgery volume 131, pages 729–737 (2011)Cite this article

Abstract

Background

Allograft–prosthesis composite (APC) for proximal femur reconstruction have shown favorable longevity and functional outcome compared to endoprosthesis, owing to restoration of bone stock, load-sharing property, and biological attachment of abductors and iliopsoas tendons.

Questions/purposes

This study examined whether a pasteurized-prosthesis composite (PPC) is comparable to APC regarding implant survival, functional outcome, and complication rates.

Patients and methods

We retrospectively reviewed 18 patients with proximal femur malignancy that underwent reconstruction with a cemented pasteurized autograft–prosthesis composite between 1993 and 2008. We evaluated implant survival (Kaplan–Meier), functional outcome (MSTS score), complications and secondary operations.

Results

The estimated survival rate of the 18 composites was 86% at 5 and 10 years. Within a mean follow-up of 93 months (median 113, range 14–163) two composites (11%) were removed due to un-resolving infection. The mean MSTS functional score of surviving 16 composites was 80% (range 70–95). Non-union and stem loosening in host bone were identified in a single patient, while infection developed in two patients. THA conversion occurred in three composites due to secondary osteoarthritis in two, and subluxation in one case. Two of the six cases, with greater trochanter (GT) reconstruction, showed GT avulsion. No autograft was fractured.

Conclusions

Pasteurized autograft–prosthesis composite (PPC) of the proximal femur has comparable survival rate, functional outcome, and complication rates to allograft–prosthesis composite (APC), thereby offering an alternative reconstructive option for proximal femoral reconstruction.

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References

  1. Anract P, Coste J, Vastel L, Jeanrot C, Mascard E, Tomeno B (2000) Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite: a comparative study of functional results, complications and longevity in 41 cases. Rev Chir Orthop Reparatrice Appar Mot 86(3):278–288

    PubMed  CAS  Google Scholar 

  2. Berrey BH, Lord CF, Gebhardt MC, Mankin HJ (1990) Fractures of allografts. Frequency, treatment, and end-results. J Bone Jt Surg Am 72(6):825–833

    Google Scholar 

  3. Biau DJ, Larousserie F, Thevenin F, Piperno-Neumann S, Anract P (2010) Results of 32 allograft–prosthesis composite reconstructions of the proximal femur. Clin Orthop Relat Res 468(3):834–845

    PubMed  Article  Google Scholar 

  4. Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus: an estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop Relat Res 240:129–136

    PubMed  Google Scholar 

  5. Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Buckley L (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Jt Surg Br 91-B:108–112

    Google Scholar 

  6. Damron TA, Sim FH (2009) Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect 49:461–470

    Google Scholar 

  7. Donati D, Giacomini S, Gozzi E, Mercuri M (2002) Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop Relat Res 394:192–200

    PubMed  Article  Google Scholar 

  8. Donati D, Zavatta M, Gozzi E, Giacomini S, Campanacci L, Mercuri M (2001) Modular prosthetic replacement of the proximal femur after resection of a bone tumour. A long-term follow-up. J Bone Jt Surg Br 83-B:1156–1160

    Google Scholar 

  9. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246

    PubMed  Google Scholar 

  10. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120

    PubMed  Google Scholar 

  11. Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res 442:223–229

    PubMed  Article  Google Scholar 

  12. Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD (2007) Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop Relat Res 459:66–75

    PubMed  Article  Google Scholar 

  13. Fox EJ, Hau MA, Gebhardt MC, Hornicek FJ, Tomford WW, Mankin HJ (2002) Long-term follow-up of proximal femoral allografts. Clin Orthop Relat Res 397:106–113

    PubMed  Article  Google Scholar 

  14. Friedlaender GE, Strong DM, Tomford WW, Mankin HJ (1991) Long term follow-up of patients with osteochondral allografts. A correlation between immunologic responses and clinical outcome. Orthop Clin North Am 30:583

    Google Scholar 

  15. Gitelis S, Heligman D, Quill G, Piasecki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop Relat Res 231:62–70

    PubMed  Google Scholar 

  16. Greene FL, Page DL, Flemming FD (2002) American Joint Committee on Cancer: cancer staging manual. Springer, New York

    Google Scholar 

  17. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126:289–296

    PubMed  Article  CAS  Google Scholar 

  18. Hejna MJ, Gitelis S (1997) Allograft–prosthetic composite replacement for bone tumors. Semin Surg Oncol 13:18–24

    PubMed  Article  CAS  Google Scholar 

  19. Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ (2001) Factors affecting nonunion of the allograft–host junction. Clin Orthop Relat Res 382:87–98

    PubMed  Article  Google Scholar 

  20. Jeon DG, Kim MS, Cho WH, Song WS, Lee SY (2007) Pasteurized autograft for intercalary resection: an alternative to allograft. Clin Orthop Relat Res 456:203–210

    PubMed  Article  Google Scholar 

  21. Jeon DG, Kim MS, Cho WH, Song WS, Lee SY (2007) Pasteurized autograft–prosthesis composite for distal femoral osteosarcoma. J Orthop Sci 12(6):542–549

    PubMed  Article  CAS  Google Scholar 

  22. Jeon DG, Kim MS, Cho WH, Song WS, Lee SY (2007) Pasteurized autograft–prosthesis composite for reconstruction of proximal tibia in 13 sarcoma patients. J Surg Oncol 96(7):590–597

    PubMed  Article  Google Scholar 

  23. Jeon DG, Kim MS, Cho WH, Song WS, Lee SY (2007) Reconstruction with pasteurized autograft–total hip prosthesis composite for periacetabular tumors. J Surg Oncol 96(6):493–502

    PubMed  Article  Google Scholar 

  24. Jeys LM, Grimer RJ, Carter SR, Tillman RM (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Jt Surg Am 87:842–849

    Article  CAS  Google Scholar 

  25. Jofe MH, Gebhardt MC, Tomford WW, Mankin HJ (1988) Reconstruction for defects of the proximal part of the femur using allograft arthroplasty. J Bone Jt Surg Am 70(4):507–516

    CAS  Google Scholar 

  26. Langlais F, Lambotte JC, Collin P, Thomazeau H (2003) Long-term results of allograft composite total hip prostheses for tumors. Clin Orthop Relat Res 414:197–211

    PubMed  Article  Google Scholar 

  27. Manabe J, Ahmed AR, Kawaguchi N, Matsumoto S, Kuroda H (2004) Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res 419:258–266

    PubMed  Article  Google Scholar 

  28. Mankin HJ, Hornicek FJ, Raskin KA (2005) Infection in massive bone allografts. Clin Orthop Relat Res 432:210–216

    PubMed  Article  Google Scholar 

  29. Masterson EL, Ferracini R, Griffin AM, Wunder JS, Bell RS (1998) Capsular replacement with synthetic mesh: effectiveness in preventing postoperative dislocation after wide resection of the proximal femoral tumors and prosthetic reconstruction. J Arthroplast 13:860–866

    Article  CAS  Google Scholar 

  30. McGoveran BM, Davis AM, Gross AE, Bell RS (1999) Evaluation of the allograft–prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour. Can J Surg 42:37–45

    PubMed  CAS  Google Scholar 

  31. Menendez LR, Ahlmann ER, Kermani C, Gotha H (2006) Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res 450:46–51

    PubMed  Article  Google Scholar 

  32. Rosen G, Marcove RC, Huvos AG, Caparros BI, Lane JM, Nirenberg A, Cacavio A, Groshen S (1983) Primary osteogenic sarcoma: eight-year experience with adjuvant chemotherapy. J Cancer Res Clin Oncol 106:55–67

    PubMed  Article  Google Scholar 

  33. Sakayama K, Kidani T, Fujibuchi T, Kamogawa J, Yamamoto H, Shibata T (2004) Reconstruction surgery for patients with musculoskeletal tumor, using a pasteurized autogenous bone graft. Int J Clin Oncol 9:167–173

    PubMed  Article  Google Scholar 

  34. Schneiderbauer MM, Von-Knoch M, Schleck CD, Harmsen WS, Sim FH, Scully SP (2004) Patient survival after hip arthroplasty for metastatic disease of the hip. J Bone Jt Surg Am 86:1684–1689

    Google Scholar 

  35. Wirganowicz PZ, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM (1999) Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res 358:64–74

    PubMed  Article  Google Scholar 

  36. Zehr RJ, Enneking WF, Scarborough MT (1996) Allograft–prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop Relat Res 322:207–223

    PubMed  Article  Google Scholar 

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

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Affiliations

  1. Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt

    Ahmed Shawky Eid

  2. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul, 139-706, Korea

    Dae-Geun Jeon, Won Seok Song, Soo-Yong Lee & Wan Hyeong Cho

Authors
  1. Ahmed Shawky Eid
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  2. Dae-Geun Jeon
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  3. Won Seok Song
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  4. Soo-Yong Lee
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Correspondence to Wan Hyeong Cho.

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Eid, A.S., Jeon, DG., Song, W.S. et al. Pasteurized autograft–prosthesis composite for proximal femoral reconstruction: an alternative to allograft composite. Arch Orthop Trauma Surg 131, 729–737 (2011). https://doi.org/10.1007/s00402-010-1194-0

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  • DOI: https://doi.org/10.1007/s00402-010-1194-0

Keywords

  • Autograft
  • Bone sarcoma
  • Pasteurization
  • Prosthesis
  • Proximal femur