Page 153 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

(pooled overall infection rate that included 48 studies on a total of 4838 patients). Albergo et al62 on the other hand, reported that the risk of failure due to infection is higher for osteoarticular allografts than for endoprostheses in a direct comparative study of 88 patients with an endoprosthesis and 45 patients with an osteoarticular allograft, although their study was retrospective and compared data from two di erent units. Both in the literature, and in our series, the risk of infection was highest in the proximal tibia. While the patients who were considered to be at high risk for infection due to poor soft-tissue coverage63 were the ones who received a muscle ap, the infection rate was lower in reconstructions with a muscle ap. Concurring with previous authors we believe that muscle aps should be used routinely in these high-risk cases64.
Our study has a number of limitations. First, we were hampered by a limited
number of patients in our retrospective study, and it was therefore not possible
to assess fully the risk factors for complications. Secondly, di erent de nitions of complications have been used in the literature, and this may have a ected the
results from our pooled analysis. Furthermore, several studies did not clearly
describe how they determined whether a complication had occurred, or how they
de ned nonunion. Thirdly, studies included in the systematic review have inherent 7 heterogeneity with regards to included diagnoses, treatment protocols, use of
additional struts and aps, osteosynthesis and cement. We were unable to adjust
for these factors and this may have introduced bias. However, we aimed to provide
an overview of current knowledge on osteoarticular allograft reconstructions in musculoskeletal tumor surgery, and this could only be achieved by combining
di erent studies and de nitions. Lastly, it should be noted that all studies included
in the systematic review were retrospective and observational, and may therefore
be graded as a low level of evidence.
An advantage of using an osteoarticular allograft for primary reconstruction is that, in case of degenerative changes, it may be converted to an allograft- prosthetic composite with relative ease. Therefore, an osteoarticular allograft may be used to delay the time for endoprosthetic reconstruction in young patients. Few series have compared the results of allografts with endoprostheses, and most focused on reconstruction of the proximal humerus30, 39, 45, 53, 65. The majority of the comparative studies concluded that allografts are associated with unacceptably high complication rates and unpredictable outcomes; reconstruction with either allograft-prosthetic composites or endoprostheses was therefore advocated as the method of choice39, 45, 53.
Osteoarticular allografts
151