Page 132 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 6
tumors. We no longer employ this technique because we assume that it results in a higher recurrence rate. The advantages of limited resection may outweigh the elevated risk of recurrence for low-grade lesions; however, 21% (three) of the 14 high-grade lesions in our series recurred and all resulted in ablative surgery. Apparently, hemicortical resection does not provide adequate local control of high-grade lesions. We therefore recommend segmental en bloc resections for high-grade tumors ( gure 5).
Computer-assisted navigation may prove useful for resecting tumors with minimal but adequate margins. All osseous margins obtained with computer- navigated resection were adequate. Several authors have shown that computer navigation is accurate and useful for bone tumor surgery44,45. Computer navigation may also be used to obtain precise matching of host and allograft osteotomies and thus superior t26,46.
Failures and Allograft Survival
Nearly all reconstruction failures occurred in the rst three postoperative years. This nding is in accordance with statements in previous reports that allografts o er a reliable and lasting reconstruction if they survive the rst critical years9,47,48. The ten-year allograft survival rate (87%) in our series compares favorably with ten-year survival rates of 58% to 69% reported in large series on endoprosthetic reconstructions after resections of bone tumors4,49,50. In those series, however, the majority of patients had high-grade malignant tumors and thus, presumably, more extensive resections. As those patients would not have been considered eligible for hemicortical resection, the results are di cult to compare.
Study Limitations
Our study had several limitations. As a result of its retrospective design, it was not possible for us to accurately assess time to union of allograft-host junctions. We were also unable to acquire functional outcome scores. Previous research, however, indicates that postoperative function is generally good after hemicortical reconstruction3.
Overview
In conclusion, we report excellent long-term rates of survival of hemicortical allograft reconstructions. Rates of non-oncological complications were acceptable, especially after reconstructions comprising <25% of the cortical circumference
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