Skip to main content
SpringerLink
Log in

Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

  • Symposium: 2010 Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–C
Fig. 3
Fig. 4A–C

Similar content being viewed by others

References

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  15. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc. 1958;53:457–481.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  17. Makley JT. The use of allografts to reconstruct intercalary defects of long bones. Clin Orthop Relat Res. 1985;197:58–75.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  21. Thompson RC, Pickvance EA, Garry D. Fractures in large segment allografts. J Bone Joint Surg Am. 1993;75:1663–1673.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  23. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am. 1994;76:657–663.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247, 1199, Buenos Aires, Argentina

    Luis Aponte-Tinao MD, Germán L. Farfalli MD, Lucas E. Ritacco MD, Miguel A. Ayerza MD & D. Luis Muscolo MD

Authors
  1. Luis Aponte-Tinao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Germán L. Farfalli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucas E. Ritacco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miguel A. Ayerza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Luis Muscolo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Aponte-Tinao MD.

Additional information

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 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.

Electronic supplementary material

Below is the link to the electronic 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)

About this article

Cite this article

Aponte-Tinao, L., Farfalli, G.L., Ritacco, L.E. et al. Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection. Clin Orthop Relat Res 470, 728–734 (2012). https://doi.org/10.1007/s11999-011-1952-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1952-5

Keywords

Search

Navigation