Page 206 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 10
in 76% of patients. The major complications were nonunion (40%), fracture (29%), and infection (14%). The median time to full weight bearing was nine months. Fifteen grafts failed, twelve of which failed in the rst four years. None of the tibial reconstructions failed. Reconstruction site, patient age, allograft length, nail-only xation, and non-bridging osteosynthesis were the most important risk factors for complications. To reduce the number of failures, we recommended to reconsider the use of allografts for reconstructions of large defects, especially in older patients, and to apply bridging osteosynthesis with use of plate xation.
It has been hypothesized that primary bone tumors can be adequately treated with hemicortical resection. Potential advantages of hemicortical resection include the preservation of joints, bone stock and cortical continuity. In chapter 6, we evaluated all hemicortical resections and subsequent inlay allograft reconstructions for primary bone tumors in a nationwide retrospective study. A total of 111 patients were evaluated for mechanical complications, infection, oncological outcome, and allograft survival. Thirty-three percent had non-oncological complications, with host bone fracture being the most common (18%). Other complications included nonunion (7%), infection (7%), and allograft fracture (3%). Of ninety-seven patients with a malignant tumor, 15% had a residual or recurrent tumor and 6% had metastasis. The risk of complications and fractures increased with the extent of cortical resection. We concluded that hemicortical resection is not recommended for high-grade lesions; however, it may be superior to segmental resection for treatment of carefully selected tumors, provided that it is possible to obtain adequate margins.
Osteoarticular allografts were commonly used to reconstruct articular defects following tumor resection in the Leiden University Medical Center after the Leiden Bone Bank was founded in December 1988. However, solid evidence on the long-term outcome of osteoarticular allograft reconstructions was lacking. In chapter 7, we presented a systematic review of the literature on osteoarticular allograft reconstructions in musculoskeletal tumor surgery, and evaluated our single-center experiences with this reconstructive technique. We included 31 studies in our systematic review. A total of 514 segmental reconstructions were analyzed. With distal femoral reconstructions as the reference, we demonstrated that reconstruction failure was less common in reconstructions of the distal radius (OR 0.3). Fractures were more common in the proximal humerus (OR 4.1) and
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