Page 119 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Introduction
The ability to accurately stage primary bone tumors has improved dramatically during recent decades, mainly because of progression of preoperative imaging techniques1,2. Concomitant advances in surgical techniques gave rise to the idea that segmental resection may not always be necessary to adequately excise primary tumors of the long bones3.
Bone tumors frequently arise in close proximity to joints, commonly necessitating resection of adjacent joints. Osteoarticular allografts, allograft-
prosthetic composites, or endoprostheses may then be used for joint replacement. Endoprostheses are generally considered the gold standard, although recent
literature describes relatively high short and long-term revision rates due to
infection, component wear, and loosening4,5. If the adjacent joint can be salvaged
and a segmental resection is performed, vascularized bular autografts or intercalary
allografts may be used. Autografts, however, can cause donor-site morbidity and, 6 until solid union is achieved, are at substantial risk for fracture. Therefore, long non- weight-bearing periods are required6. Intercalary allografts o er superior initial
stability, but demonstrate high rates of nonunion (27% to 47%), fracture (16% to 29%), and infection (1% to 14%), causing failures in 14% to 24% of cases7-10.
Compared with the aforementioned techniques, hemicortical resection o ers potential advantages, including preservation of joints, bone stock, and cortical continuity. It may result in lower complication rates and allow faster and more complete rehabilitation3,11,12. Various reconstructive techniques have been described, including implantation of cortical allografts, autografts, and autologous iliac crest grafts3,11-15. Allografts have been most commonly used, but there is a lack of studies of large series with such reconstructions.
Most reports on hemicortical resection focused on treatment of low-grade and surface tumors of bone, such as parosteal osteosarcoma, adamantinoma, and peripheral chondrosarcoma3,11,12,14,15. More recently, authors have described experiences with limited resection of high-grade lesions13,16. The authors of most studies on hemicortical resection of bone tumors reported that no recurrences occurred3,11-15. However, they described small case series that mostly lacked long- term follow-up, and low-grade tumors may recur years after surgery17-20.
The aims of our study were to evaluate (1) mechanical complications and infection, (2) oncological outcome, and (3) failures and allograft survival after hemicortical resection and subsequent allograft reconstruction in patients treated for a primary tumor of a long bone.
Inlay allografts
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